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PRACTICAL ACCOUNT 



OF 



THE EPIDEMIC CHOLERA, 



t f 

S r 



a rr 



■:> 



. t- . _ 






PRACTICAL ACCOUNT 



THE EPIDEMIC CHOLEBA, 



THE TREATMENT 

BEQinSITE IN 

THE VARIOUS MODIFICATIONS OF THAT DISEASE. 



By WILLIAM TWINING, 



LONDON: 
PAJIBURT, ALLEN, & Co. ' .'lAJ 
LEADEHHAIJ. STREET. 

1833. 



Y^' 




33. 



7i- 



1 




SSELL, M.D., 

-ral Hotpilal, CaleutUi, aud 
,'irdofHeaUk, London. 



i'ored to your notice, in testi- 
iiibrance of the kindness with 
..inrag«i every pathological in- 
many years that I was on duty, 
■ ilers, at the General Hospital in 
■i of the readiness with which your 
iiince of the diseases of India was 
lilable for the benefit of the sick in 
iiiitiition. I doubt not that some of 
■ .« iiig pages will bring to your recollec- 
i> arduous duties of foitner days. I could 
nftrred to you, regarding some of tlie 



X PREFACE. 

been various. The more deliberate and labo- 
rious investigations have been made in the 
General Hospital, and among the cases which 
have occurred in the city of Calcutta and its 
vicinity ; where the disease almost always exists 
in some of its forms. The early part of my 
service in the Upper Provinces of India, enabled 
me to observe the disease during the cold sea- 
son in the vicinity of the great snowy moun- 
tains which divide this country from Tartary, 
and in situations where we might suppose, from 
a considerable similarity, of climate during win- 
ter, that modifications of cholera would be found 
similar to those which occur in the northern 
parts of Eiut)pe. In those districts I found 
sporadic cases of Cholera, exhibiting the same 
symptoms, following the same course, and ter- 
minating in the same manner that the disease 
does in the low flat country and humid atmos- 
phere of Bengal Proper, It appeared to me, 
that during the cold weather in the Upper Pro- 
vinces, the proportion of instances in which the 



PREFACE. XI 

functions of the lungs seemed impeded by a 
morbid secretion of mucus in the bronchial 
tubes, was greater than I have observed in other 
parts of the countiy, and a wheezing noise in 
respiration was there an occasional symptom. 
In some ca^ it was attended with considerable 

r 

expectoration of mucus. 

I have endeavoured to add to our know|edge 
of Cholera, by diligent observation of all the 
phenomena connected with its origin, progress, 
and termination, and of the effects produced by 
remedies in various forms and stages of the 
disease. My attention has been particularly 
directed to the condition of the blood, and to 
the deviations which take place, from the heal« 
thy state of many of those functions that can be 
observed during life, as well as to the morbid 
changes noticed in dead bodies on post-mortem 
examinations. Out of a multitude of observa- 
tions recorded on these subjects, I now offer to 
the public such as appear to me illustrative of 



XU PREFACE. 

the nature of the disease, and likely to be of 
practical utility. 

I have not mentioned any peculiar odour, as 
characteristic of Cholera, because I am not able 
to distinguish any particular smell, either of the 
perspiration or of the evacuations, that I could 
deem characteristic of the disease, and not found 
in some others. However, my occupations in 
the pursuit of morbid anatomy may make my 
testimony on this head less conclusive ; and I 
should be unwilling to enter into any discussion 
on this subject, with those who may be of a dif- 
ferait opinion. 

. Perhaps my readers may consider that undue 
attention has been bestowed on an inquiry into 
the nature of the peculiar alvine evacuations, 
usually described as resembling rice-water, and 
denominated the true Cholera stools; but as 
the results of all my examinations and analyses 
authorize me to differ from many authors of 



PREFACE. Xm 

respectability, who speak of such stools as serous 
fluids, or more distinctly assert that they are 
the serum of the blood, I have thought it neces- 
sary to go somewhat more into detail on that 
subject than was requisite on other points, where 
my observations confirm the opinions of my pro- 
fessional brethren, or, at all events, do not 
directly contradict them. 

For the purpose of preventing mistakes in the 
administration of remedies, by the young appren- 
tices at the Hospital, it is the custom in this 
country to write the instructions for taking the 
different medicines, in English, under the Latin 
prescriptions. They have been copied in the 
same way into my note-book, and I have not 
thought it necessary to make any alteration, my 
only object being to convey an accurate account 
of the disease, of the treatment employed, and 
of the results which followed. 



CONTENTS. 



Page 

Symptoms of Cholera ' • • • • 1 

Disordered Functions of the Lungs during Cholera 23 

State of the Blood in Cholera 26 

Nature of the Watery Stools and Matter vomited • • 29 
State of the Urine in Cholera 33 

Pathological Remarks 34 

Progress of the Disease towards Recovery or to 

Fatal Termination 38 

Morbid Appearances observed on Dissection .•...• 45 

Causes of Cholera • . • 55 

Treatment 61 

Cases of Cholera connected with febrile or inflam- 
matory Condition 78 

Blood-letting injurious in some Descriptions, and in 

certain Stages of the Disease 141 

Arteriotomy in Cholera. 156 

Cases attended with early Collapse — ^treated first by 

Opium and Stimulants •• 168 



XVI CONTENTS. 

Page 

Galvanism in Cholera 207 

Mercurial Saliyation does not prevent an Attack of 

the Disease 211 

Cholera in Children 224 

■ in Asiatics 230 

Cases, shewing the Stage of the Disease at which 
the Secretions were taken for Examination and 

Analysis 235 

Facts relative to Contagion 258 



CHOLERA. 



Vomiting and purging are the symp- 
toms of Cholera, which most commonly 
first attract the attention, and excite the 
alarm of patients. The importance and 
danger of these symptoms must be esti- 
mated according to the nature and dura- 
tion of various concurrent phenomena. 
With the first eflForts of vomiting and 
purging, the ordinary contents of the 
stomach and intestines, in most instances, 
seem to be entirely expelled ; after which, 
as the disease goes on, an aqueous fluid 
like rice-water is voided by stool : that 
which is vomited is nearly of the same 
sort, hut has generally its appearance 
modified by the remedies administered. 

B 



2 CHOLERA. 

The whey-like appearance of the stools 
is so commonly. attendant in the worst 
cases, that it is often spoken of as the 
true cholera stool, or the congee stool. The 
evacuations are sometimes nearly as clear 
as pure water, and frequently some films 
of mucus are floating in this sort of fluid. 
The incipient degree of favourable 
change in the disease, is marked by a 
transition from the states of the evacua- 
tions above mentioned, to a drab-colour, 
then to a grey, and subsequently to a 
darker colour as the improvement goes 
on^ 

Besides the above symptoms, we find 
in Cholera, sudden and extreme prostra- 
tion of strength; the countenance is 
either pale or livid ; the eyes are much 
sunk in their sockets, as if from the 
sudden absorption of the surrounding 
fat, and shrinking of the cellular struc- 
ture of the orbit. There is generally a 
degree of livid venous congestion of the 



CHOLERA. 3 

scleroticae and conjunctivae, though some- 
times a florid arterial suffusion of the 
eyes is observed- The sunk eyes, shrunk 
features, and ghastly expression of coun- 
tenance, are so remarkable and peculiar, 
as to be immediately recognised by those 
who have once seen a cholera patient. 
The medical man whose illness is men- 
tioned in a subsequent part of this chap- 
ter, had no suspicion of his disease 
being Cholera, till about noon of the day 
on which he died, when he desired his 
servant to bring him a small looking- 
glass, and the instant it was brought, he 
said, " I see I have got Cholera,* which 
I did not even suspect before : there can 
be but little hope of my recovery." He 
had suffered no spasms, and from there 
having been a slight bilious tinge in the 



* This gentleman had only seen a few well- 
marked cases of Cholera in the Hospital, about a 
month before. 

B 2 



4 CHOLERA. 

stoohi, he had not been aware of the 
nature of his complaint at its early 
stag^, and thus lost his life. 

In bad cases, the voice becomes feeble, 
shrill, and pectoral; respiration short, 
diflScult, and imperfcQt; the tongue is 
cold and moist ; coldness of the whole 
body, but more especially of the ex- 
tremities, and a shrivelled state of the 
fmgers, takes place. This mortal cold- 
ness is sometimes coeval with the earliest 
symptoms of Cholera, but I have never 
known it attended with shivering or 
rigours, like the cold stage of ague, in 
which the patient earnestly demands 
more bed-clothes : on the contrary, the 
cholera patient when coldest throws off 
the blankets, tosses about in anxiety, 
and calls for cold drink. The cessation 
of the calorific function is as remark- 
able during the hot weather as at the 
coldest season of the year ; in fact, the 
hot bath, hot vapour, or other means of 



CHOLERA* 5 

producing artificial warmth, often have 
not the slightest effect ; although inani-» 
mate, bodies exposed to the same means 
of raising the temperature, are quickly 
heated. When the spirit vapour has 
been employed, the wood, and cane of 
the. bedstead may be felt quite hot^ while 
the^ patient . lies as cold as. before the 
vapour was used. When the tendency 
to collapse commences, the surface of 
the body (particularly about the chest 
and upper extremities) is wet with a 
profuse cqld sweat, the pulse becomes 
weak, rapid, and indistinct; there is 
often great oppression at the scorb. 
cordis, and occasionally a sense of burn- 
ing heat at that part, with anxiety and 
restlessness* 

The belly, is sometimes. tense, tumid, 
and painful on pressure ; but this is rare, 
the usual condition of the abdomen 
being flat, doughy, and inelastic. In a 
few rare, instances of irritable, and ner- 



6 CHOLERA. 

vous subjects, there is vast extrication 
of intestinal flatus, with a sort of roar- 
ing hickup. In advanced stages of bad 
cases of the disease, ordinary hickup is 
sometimes a transient symptom. Intense 
and distressing thirst soon takes place, 
in almost all the severer attacks of Cho- 
lera ; and a sensation of noise in the 
ears, or some degree of deafness, occurs 
in a considerable number. 

Spasms of the extremities though 
present in the majority of cases to a 
certain degree, during some period of 
the disease, are sometimes entirely ab- 
sent in patients where death takes place 
very suddenly; and even in some pro- 
tracted cases, where nearly all the other 
more aggravated symptoms above enu- 
merated precede the fatal event. The 
spasms generally begin in the toes and 
fingers, then, after affecting the calves 
of the legs very violently, they often 
proceed to the thighs and belly. 



CHOLERA. 7 

Some patients have very little of either 
vomiting or purging ; the earliest appa- 
rent symptoms seeming to announce 
the general failure of vital energy, and 
the incipient death of the patient. Sucli 
is the variety in the disease, that I could 
not mention any symptom of Cholera 
which is not occasionally absent, in 
cases which terminate in death with the 
most awful rapidity. I have met with a 
few cases, in which the patients came to 
hospital with the same coldness of the 
extremities, shrivelled fingers, and ol> 
structed circulation, as above described ; 
at the same time that they were passing 
a thin bloody fluid, not unlike thin 
chocolate. These patients had usually 
been ill three or four days, and died 
within twelve hours of admission into 
hospital.' On dissection, the most in- 
tense degree of lurid, duskey-red colour 
of the mucous membrance of the great 
intestines was observed, especially at 
the coecum ; inflammation of the small 



8 CHOLERA. 

intestines, and morbid vascularity of 
omentum and mesentery. This condi- 
tion was only observed in neglected 
cases of several days duration, of which 
no distinct history could be obtained. 

With almost every year I have ob« 
served the above symptdms to vary in 
severity, as well as in the order of «uo- 
cession ; and to be combined In difi^rent 
ways. In some seasons, the ordinary 
characters of the disease are in the 
majority of cases attended by a febrile 
affection more or less distinct ; spasms 
are then generally violent and painful, 
causing the patient to cry aloud: the 
efforts to vomit are violent, hut the 
quantity of fluid voided both upwards 
and downwards is frequently not very 
great. The pulse, though rapid, not 
sinking very soon, and the warmth of 
extremities not suddenly ceasing. In 
such cases the vascular congestion of 
the eyes is commonly of a florid arterial 



CHOLERA* 9 

character; the tongae furred, ofbeQ 
brownish, and usually warm ; som^tix^es 
it is dry and very slightly furred. During 
other, seasons, ih^ greater number of 
Isevere cases become cold at an early 
period, the evadui^tions mostly very 
copious and watery^ the pulse sinks 
rapidly, and become^ indistinct; the 
voice i^ feeble, shrill, and pectoral, or 
entirely inaudible; congestion of the 
eyei^ of lurid veiiioits character, and a 
lurid coloui: qf the. face and n^ck take 
.places as if from stagnation of venous 
blood : $pasmsf, when pre^e^t, Q.re thea 
attended with leiss pain; and torppi;, 
insensibility, and death, soon close the 
scene, ThQ affection of the head, in 
remote stages of the disease, sometimes 
resembles coma ; and ii^ a few rare ca^s 
transient delirium exists, but generally 
we find the intellectual feculties remark- 
Iibly clear and undisturbed during the 
.whole course of Cholera. In other years 
niaay cases are of a Qiixed character, 

B 3 



10 CHOLERA. 

beginning with febrile tendency ; and a 
few of them are found vomiting much 
green bilious watery fluid at first ; but 
rapidly sinking into the state of coI«- 
lapse, with cessation of pulse, cold 
tongue, and shrivelled extremities. This 
appears to me a common form of the 
disease in the last two years, since Cho- 
lera has become much less frequent. 

The commencement of the disease 
with febrile symptoms; and their con- 
tinuance, while the constitution shews 
signs of sensibility, action, and power ; 
the warmth and circulation remaining, 
and the evacuations though frequent 
never having been very profuse, indi- 
cate a tractable state of disease, in which 
the best results may be hoped from a 
cautious, steady, and discriminating 
treatment. While the early accession 
6f torpor, which defies the effect of 
medicine, with cold and shrivelled ex- 
tremities, cessation of pulse, cold tongue, 



CHOLERA. 1 1 

and copious evacuations, indicate a 
modi&^ation of disease in ivhich, we 
have but little to hope in the majority of 
casei^. after these symptoms have existed 
for four hours. 

We must always bear in mind, that 
those, who are affected with the febrile 
form of the disease, do frequently in a 
short period sink into a state of coldness 
and torpor : and on the other hand, also, 
that in the last stage of collapse there 
are sometimes symptoms of a short and 
ineffectual re-action of the system, with 
morbid heat about the head and chest, 
for a few hours before death; but there 
is rarely a .return of steady and regular 
-pulse. Vomiting, purging, and spasms, 
frequently all cease for some hours be- 
fore death. 

Whenever an epidemic visitation of 
Cholera occurs, affecting suddenly a 
number of persons in one place, a large 



12 CHOLKRA. 

proportion of the earlier cai^es are Qsually 
of' a very severe description, with ten- 
dency to early acce^ion of eoldnessh 
torpor^ and collapse : a considerablejium* 
ber of these appear inevitably fatal. 
During the first three or four days of an 
epidemic visitation, the rapidity of the 
progress of Cholera towards fatal termi- 
nation seems to increase. I am not 
aware that the severer form of the dis* 
ease has ever continued permanent in a 
station so long as six days; and by the 
eighth or tenth day we commonly find 
only slight cases occurring. Inattention 
to this &ct is liable to lead to erroneous 
estimation of the efficacy of any plan, 
or of the various modes of treatment 
.employed. On one occasion, when Cho- 
lera occurred in a severe form in detach* 
ments recently arrived from Europe, 
nineteen men died of the twenty-one 
first attacked with the disease ; and of 
the next thirty^one cases which occurred 
on the following days, in the sanie de* 



CHOLERA. 13 

tachment, six oniy died : a still milder 
form of Cholera succeeded, and tiie 
whole of the patients then recovered. 
This occurred in May 1827; and the 
plan of treatment, which was inert in 
the. early cases of the disease, was at- 
tended by the most happy results at a 
more remote period of this endemic 
Cholera, in the«ame detachment. 

The invasion of Cholera most ire* 
quently appears in a violent form, be- 
tween the hours of two and five a.m. 
garding the mode in which this 
begins, I may observe that a careful re* 
ference to my experience authorises me 
to say, that its attack often commences 
suddenly, and without any premonitory 
symptoms : sometimes it abruptly, supers* 
venes on the advanced stage of severe 
acute Dysentery. The Cholera is occa- 
sionally preceded by a slight pyrexia; 
and it has also appeared to me, that 
conge$tive fevers do sometimes, thoi^ 



14 CHOLERA. 

rarely, fall into a state of collapse resem- 
bling the low stage of this disease; not 
indeed very often attended with violent 
vomiting and cramps, but the patient 
suddenly becomes weak and cold ; some- 
times voiding one true Cholera stool : at 
other times, even this symptom is absent* 
After the sudden death of fever-patients 
in this manner, I have several times 
found, on dissection, the thickened state 
of the coats of the small intestines, and 
that portion of the canal loaded with 
pale, watery fluid, like rice-water ; with 
much of the subalbid mucus, and thick 
white paste, which are usually considered 
characteristic of Cholera. In short, the 
sudden collapse which occasionally su- 
pervenes at the termination of a paroxysm 
of remittent fever, somewhat resembles 
the collapse in Cholera. 

Prior to the more distinct and alarm- 
ing attack, there are sometimes for a few 
hours, and in some cases for two or three 



CHOLERA. 15 

days, symptoms of indisposition, evi- 
dent not only to the patient himself, but 
to his friends. When Cholera is raging 
severely, the disease is often ushered in 
by diarrhoea; at other times it begins 
with catarrh, nausea, and oppression at 
the scrobiculus cordis ; which are not in 
an early stage to be distinguished from 
the slight indisposition which often pre- 
cedes Fever. The approach of Cholera 
in this manner makes the patient sup- 
pose he is "feverish or bilious;" and if 
recourse be had to some of the medicine^s 
commonly used in slight ailments of that 
sort, the disease is said to be caused by 
the dose of medicine taken; when, in 
fact, it had been insidiously making con- 
siderable progress for some hours. When 
Cholera is prevailing in the vicinity, 
slight catarrhal, or febrile affections, and 
disorder of the stomach and bowels, whe- 
ther tending to diarrhcBa or to constipa- 
tion, seem convertible into Cholera by 
the use of saline or drastic cathartics, 



16 CHOLERA. 

more especially if Hiey operate about 
two or tkree o'clock in the morningi. 



CasiS I. — ^A geiitleinan of dark com- 
plexion, and genially very heakhy, of 
regular and , moderate habits^ twenty- 
eight year^ of age, and five years in Ben- 
gal^ awoke on the morning of the 1 8th 
March 1830, with flight feeling of unea- 
siness, which he ascribed to. indigestion, 
and therefore on returning from his usual 
morning ridc^ took a small dose of Epsom 

: salts; soon fifter which nausea took 

* 

place, and a cup of tea Was vomited two 
hours after taking the salts : the extrcf^ 
mities soon became cold and shrivelled, 
voice weak and pectoral, tongue cold, 
-countenance livid, eyes sunk, and cor- 
nea dulL . Th9 pulse gradually grew 
feeble and indistinct ; there were occa^ 
Btonal slight efforts to vomit, at intervals 
of half an hour; and only four stools 
from the commencement to the termi- 
nation of the attack : the two first of 



CHOLERA. 17 

these stools very copioas, and like grey 
water ; the other two scanty ,"imd of piale^ 
drab colour. There was dreadful anx'* 
iety, some thirst, and occasionally slight 
cramp, by which the fingers and toes 
wer6 drawn up, but not very great pain. 
He died at four p.m., nii^ hours after 
taking the salts. The few cases of Cho- 
lera occurring about this time, had for 
the most part a tendency to sudden cdl* 
lapse. 

» * • * 

Case II. — ^A stout and luipalthy woman, 
^wenty»two years of age, eight years in 
India, was recovering in a satisfactory 
manner after her ax^couchement, nursing 
her infimt, and beginning to go about the 
house: on the 14th September, 1825, 
which was the twenty-second day after 
the birth of the child, she felt slightly 
feverish, and took six grains of calomel 
at bed-time, not being considered seri- 
ously sick, either by herself or the family. 
She rose at two a.m. on the Idth, to let 



18 CUOLEHA. 

her boy suck, but made then no com* 
plaint : soon after three o'clock a pro- 
fuse purging of dark fluid took place ; 
some of the evacuations passed in bed, 
and those that were last voided were 
a pale-grey water; there was neither 
vomiting nor spasms; the hands and 
feet became cold, and she died at a 
quarter past five, in less than two hours 
and a-half after the first purging. This 
woman was living in tolerable comfort, 
in an upper-roomed house, had not been 
down stairs since her confinement, and 
the friends asserted that she had not 
been imprudent in diet, or in any other 
respect. Cholera of a severe description 
was at this time frequent among the na- 
tives, in the immediate vicinity of this 
person's house. 

Case III. — Michael Hammon, H. M. 
13th Light Infantry, a stout young 
man, eighteen years of age, recently 
arrived from Europe, felt some slight 



CHOLERA. 19 

ailment on the 20th May, and came to 
hospital on the night of the 21st, with 
pain at upper part of belly, constipation, 
and slight fever : he had an enema, and 
castor oil in the night, and senna and 
salts on the 22d, by which he was freely 
purged, and appeared to be getting 
better; on the 23d, twenty grains of 
jalap and as much cream of tartar were 
given, which acted very freely during 
the day; and about two a.m. on the 24th 
a watery purging took place, with cold- 
ness of extremities, feeble pulse, dread- 
ful thirst, and cramps : his life was saved 
with difficulty, and he was discharged on 
the 13th June. 

There were several very bad cases of 
Cholera in the Hospital at this time ; and 
within a few days, other men of the same 
detachment were admitted into Hospital 
with Spasmodic Cholera, and some of 
them died. 



20 CHOLSRA. 

I have known more ihan one case, 
where persons feehng some slight indis- 
position, have taken a dose of rhubarb 
and magnesia, with a small quantity of 
ginger, early . in the morning ; after 
which, distinct Cholera symptoms ap- 
peared, with the first purgative e£fects of 
thfi « medicine, by ten o'clock ; and the 
disease proved fatal within twelve hours. 
Itt^ is evident, in most such cases, that an 
insidious attack of Cholera was going on 
before the medicine was taken. How- 
ever, I am of opinion, that when Cholera 
is prevailing, drastic purgatives, parti- 
cularly senna and salts, or jalap, have 
frequently brought on the disease in per- 
sons who had at the time only slight 
pyrexia; and who, if left without active 
purgatives, would not then have had 
Cholera. The experience of many years 
has so far confirmed this opinion, that we 
usually are cautious in ordering either 
jalap or salts in the Hospital, when we 
have many patients with Cholera under 



CHOLERA. 21 

treatment here, or when that disease is 
prevailing in the town; and at such tinies 
it is deemed hazardous to give a patieiot 
any medicine likely to act on the> bowels, 
between two and five a.m. : therefore we 
have usually, if possible, avoided giving, 
even to febrile cases, on those occasions, 
calomel and colocynth at bed time. I do 
not remember ever having heard the 
commencement of ah attack of Cholera 
imputed to a dose of castor oil. 

Case IV. — ^Michl. Regan, a recruit, 
recently landed from Europe, who had 
been eleven days in Hospital with ca- 
tarrh, was, quite well, and ordered to be 
discharged in the afternoon of 10th Dec. 
1825, to join his Regiment. He ate his 
dinner as usual, and in a few minutes he 
vomited : the worst symptoms of Cholera 
soon came on, and he died of that disease. 
There was no want of prompt and assi- 
duous attention in this case, for I was in 
Hospital at the time that he began to 



22 CHOLERA. 

vomit, and saw him in less than fifteen 
minutes afterwards. 

Case V. — A stout and healthy lady, 
of light complexion, aged twenty-six, 
who had been fifteen months in India, 
was attacked with vomiting and purging, 
at three o'clock p.m., on the 2d Septem- 
ber, 1825: spasms of the extremities 
soon came on, and by five o'clock col- 
lapse had taken place to such a degree 
that her life was despaired of: she died 
before dark the same evening. This 
person had been quite well up to the 
moment of the attack : ate her tiffin as 
usual, and was afterwards occupied in 
arranging books in the library ; standing 
on a chair to place those on the upper 
shelves. When so occupied, she felt 
sick, in consequence, as she supposed, of 
reaching too high : in a few minutes 
after the first sensation of sickness, she 
began to vomit, and allthe worst symp- 
toms of the disease quickly followed. 



CHOLERA. 23 

I have met with many instances, when 
in the Upper Provinces, where Sipahees, 
who marched from the Camp early in 
the morning quite well, have suddenly 
fallen to the ground, with violent spasms 
of the extremities; and in whom vomit- 
ing, purging, coldness, and all the worst 
symptoms of Cholera came on quickly. 



Some other phenomena, not yet des- 
cribed, are so intimately connected with 
the character of Cholera, and indicative 
of the morbid changes which take place 
in that disease,^ that they deserve parti- 
cular attention. When the patient, from 
the first attack, sinks rapidly into a low 
state, with feeble pulse, cold extremities, 
shrivelled fingers (as if from long mace- 
ration in water), and weak pectora.1 voice, 
the carbonic acid gas evolved by respi- 
ration is much less than that contained 
in the air from the lungs of persons in 
health. I have several times found the 
quantity of carbonic acid gas, as low as 



24 CIIOLICRA. 

J '6 per cent.* of the air expired from 
thp lungs of. patients . in the state de** 
scribed above ; and seldom .so much as 
two per cent. : whereas air from the 
lungs of patients suffering from febrile 
Cholera, with violent and pfdnful spasms, 
free pulse^ and warmth of surface ; ^ con- 
tained 3*5 to four percent, of carbonic 
acid gas, and sometimes more. I have 
been particularly careful in the mode of 
procuring the air from the lungs for 
these experiments, and have made nu- 
merous trials on the expired air of healthy 
persons, in order to enable me to speak 
confidently on this subject. I make the 
patient take rather a forced inspiration ; 
and then holding , the nose till some of 
the air is expired by the mouth, have 
the apparatus ready io collect the next 
portion for experiment ; hoping by this 



* In these cases^ I have reason to believe that 
the pulmonary vapour^ or exhalation^ is much di- 
minished* 



CHOLERA. 25 

means to procure a portion of air that 
has been fairly subjected to whatever 
vital and chemical action may be going 
on in the lungs. By always using these 
precautions, and operating on one given 
quantity of air, I hoped to insure a rela- 
tive uniformity of results, and the great, 
est possible precision. It is often very 
difficult to procure even ten cubic inches 
of air in a satisfactory manner, from the 
Itings of a person in a state of lowness 
and collapse, when restlessness and ex- 
treme anxiety prevail. It appears to me, 
that the great discrepancy stated in the 
results of eudiometric experiments on 
the respired air of healthy persons ; when 
those viho conducted the analyses were 
men of equal eminence, and undoubted 
accuracy; must have arisen from their 
having not observed similar precautions 
in collecting the air for their operations : 
for there has been a tolerable uniformity 
in the result of the experiments made by 
each person; though in some cases a 

c 



26 CHOLERA. 

difference of nearly one-half, from the 
conclusions of others. 

When we can succeed in bleedii^ a 
man, who is in the state of lowness and 
collapse, while torpor is impending ; we 
find the blood is generally thick, black» 
and tarry, trickling down the arm in a 
slow and unsteady stream ; and the flow 
very often entirely ceases as soon as the 
veins of the fore-arm are emptied. This 
blood usually coagulates into an uniform 
mass, without separating any serum ; and 
the surface of the cruor, after standing 
till it is cold, becomes somewhat more 
florid than when first drawn. In other 
eases, the dark-coloured blood separates 
a small quantity of reddish serum, which 
exhibits no peculiar character except its 
colour : and when heat is applied to this 
discoloured serum, it fornis a firm, dry, 
friable coagulum, which in a few in- 
stances is of a pale, dusky green colotor. 
When Cholera is attended with febrUe 



CHOLERA. 27 

symptoms, the blood generally separates 
into serum and crassamentum, nearly as 
in healthy subjects ; though the quantity 
of serum varies considerably, and some* 
times the surface of the cruor is remark* 
ably florid ; not unfrequently it exhibits 
the bufiy coat, indicative of local inflam* 
mation ; several e;2&amples of which wiU 
be detailed. I acknowledge having two 
or three times seen the cruor quite florid, 
and still the patient has rapidly sunk 
into a cold and torpid state after the 
Y, S. and, although the bjood flowed 
freely, the patients were lowered, and 
made worse by it : but this florid appear- 
ance has been so rare, as not to have 
allowed sufficient opportunities of ascei^ 
taining satisfactorily the circumstances 
Qonnected with it, in such cases as have 
terminated fatally. 

The subalbid fluid, usually denomi* 
nated the true Cholera stppl, or the Qon<* 

jee stool, 1ms been repeatedly ftnd c»ra» 

c2 



28: GtiOLERA. 

fully analysed ; as well as the fluid ejects 
ed by vomiting. Of the latter it is im- 
possible to speak with any confidence, 
except in cases where the patients have 
been a considerable time in Hospital, 
and carefully watched, so as to ascertain 
what fluids may have been drank, and 
what remedies taken': consequently, it 
has not been possible to make so many 
satisfactory examinations of the fluid 
that is vomited. In a case of febrile 
Cholera, attended with profuse evacu- 
ations, I have by the smell recognised 
peppermint water, which had passed 
through the intestines iii about two hours^ 
and a-half : and have been able to de- 
tect in the stools, fluids acidulated with 
cream of tartar, which had been drank 
less than three hours before . Therefore, 
if the analysis of Cholera stools be deem- 
ed important, the circumstances of the 
disease and nature of the ingesta should 
be attended to. The following results 
have been obtained, on examination of 



CHOLERA, 29 

■ 

the fluid vomited; and of the watery 
and subalbid stools usually admitted to 
be characteristic of Cholera. 

The Cholera stools frequently consist 
of two portions; a thin watery fluid, 
and a pale-grey thicker substance like 
dirty mucilage, or the sediment in barley 
water, part of which will pass through a 
muslin strainer with the more watery 
portion ; and if left in a large test-tube 
for four hours, the thicker part subsides, 
and is found to possess the following 
properties : 

a It is in slight degree soluble in cold water. 

fi The greater part is soluble in a mixture of 
equal parts of distilled water, and Liquor Ammoniae. 

y Exposed in a small evaporating dish to the 
heat of the' spirit-lamp, it dries into a thin pellicle, 
which does not contract much when heated : but 
in the progress of desiccation, it exhales a nauseous 
odour of putrid flesh. 

The subalbid fluid, which floats on the 



80 CHOLERA. 

pot, when the true Cholera stools are left 
to settle in the test-tubes, affords the 
following indications : 

«K WMi Ikmiis^ Yery seldom any effect is pro- 
duced ; and when any is observed^ it is a slight 
reddening of the Htmus paper^ denoting ithe pre* 
aence of an add. 

fi Exposed to heat^ it does not coagulate ; even 
if the temperature be raised to the boiling point. 

V Treated with pure alcohol^ it is not coagu- 
lated ; but in a few rare cases^ a very trivial cloudy 
Opacity appears on the addition of the Alcohol. 

) Treated with a solution of oxymuriate of mer- 
cury in distilled water ; sometimes a slight opaque 
doud is formed^ which in twelve hours subsides 
to the bottom of the test-tube : forming a minute 
sediment like mucilage^ not amounting to ^ of the 
quantity of ffuid tested. 

f Solution of subacetate of lead> when dropped 
into the iBuid^ even in the most minute quantity^ 
instafitly causes a curdled appearance^ and a preci- 
pitate subsides in the course of an hour. This is 
in such remarkable quantityy that the sediment 
amounts to from one-third to one^eighth of the 
quantity of fluid tested^ 



CHOLERA. 31 

( The iiifudon of galls sometimeii causes a slight 
turbidness : and in some of the experiments a few 
very light films were formed, which slowly sub- 
sided towards the bottom of the tube in the course 
of twelve hours. If left to stand for two or three 
days^ the fluid at the top of the test-tube becomes 
of a rusty brown colour, which after a longer pe- 
riod is changed to black. 

Tb^ Cholera stools which appear like 
ckdr water^ afford the same indications 
as above stated^ when tried with the 
several tests : but on the addition of so- 
lution of subacetate of lead, the curdled 
appearance instantly produced, is of a 
more snowy whiteness ; and when this 
subsides, it is much smaller in quantity 
than the precipitate of a subalbid cholera 
stool, tried with the same test. 

The fluid vomited in cases of Cholera 
when obtained under circumstances which 
gave reason to believe that the secretion 
of the stomach was obtained iree from 
the fluids recently drank, only differs 



32 chol£Ra/ 

from the above in being more viscid and 
slimy : the results of analysis have been 
the same as those afforded by the more 
fluid portion of the conjee stools ; but 
the indications of the presence. of an acid 
have been stronger. 

The results of a multitude of experi- 
ments accord generally with these state- 
ments. Without entering into minutiae, 
concerning the conclusions deducible 
from the above ; it is evident from Ex. 
/3. that the subalbid evacuation, called 
the true Cholera stool, does not consist 
of the serum of the blood, as some au- 
thors have stated. I have found the 
conjee stools not coagulable by heat, 
whenj the blood of the same patient has 
separated a small quantity of serum, 
which has coagulated firmly on the ap- 
plication of heat. The occasional indi- 
cations of an acid in the Cholera evacu- 
ations ; while we know that uncombined 
soda is generally found in serous fluids ; 



CHOLERA* 33 

would be an additional reason for our 
not acknowledging the conjee stools to 
be the serum of the blood* 

By the employment of Dr. Bostock's 
test, the subacetate of lead, in Ex. s» 
the peculiar secretion of Cholera is 
proved to consist chiefly of mucus. We 
may therefore conclude that the Cholera 
stools consist of mucus, and a peculiar 
mOrbid secretion; without any appre- 
ciable quantity of the serum of the blood. 

In a subsequent part of tliis chapter I 
.will mention a few cases, shewing the 
state of the patient and the stage of the 
disease, when the evacuations were taken 
for analysis. 

When the kidneys continue to secrete 
during Cholera, the urine appears to be 
nearly the same as that of a healthy 
person; in containing urea, and the or- 
dinary salts of the urine: whether ex- 

c3 



34 CHOLXRA. 

actly in the usual proportions, I have 
not been able to determine. In some 
cases, the small quantity of limpid urine 
first voided after a suppression of that 
secretion for several hours; appeared 
to contain a large quantity of animal 
matter, and the putrefactive changes 
were observed to take place in it very 
early. • 

In the assemblage of symptoms which 
constitute the early stage of a sudden in* 
vasion of Cholera ; we observe evidence 
of the disorder, or total cessation of the 
functions of those organs, which are sup- 
plied with nerves from the great solar 
plexus. In those cases tending to early 
collapse and coldness, the liver and kid^ 
neys cease to secrete as usual ; the di- 
gestive powers are arrested, the mucous 
membrane of the stomach and intestines 
has its secretions altered ; and the dis- 
order of the respiratory function, re- 
minda us of the alliance in the healthy,. 



^ ««**' '>.«&» 



CHOLERA. 35 

as well as diseased actions of the lungs,^ 
with the digestive organs ; through the 



* Whoever undertakes an accurate pathological 
inquiry^ relative to the nature of Cholera> and has 
extensive opportunity to pursue his investigations ; 
will find many reasons for concluding, that among 
the most important lesions of function which take 
place in that disease ; the decarbonising power of 
the lungs is affected to a very great degree^ more 
especially in those cases which are attended with 
early collapse and coldness^ and are void of any 
febrile and inflammatory symptoms. In connection 
with this subject, we have occasion in post-mortem 
examanatH>ns sometimes to observe the contents of 
the coecum and cokm black, when the contents of 
the small intestines are of a lighter colour. These 
facts will induce us to inqtdre whether the black 
colour of the contents of the colon, and of the stools 
which appear during life in certain stages of Cho- 
lera, be in all cases dependent on black cystic bile. 
is there not reason to conclude, that the black se- 
icretions in the coecum and colon, may depend on an 
effort of nature to compensate by a carbonaceous 
secretion, for the inefficient action of the lungs and 
skin > Many pa(tients die of Cholera before such 
secretion is established. 

Viewing 



w^ 



3ff CHOI^BRA. 

influence of the nervous system generaUyf 
and more especially of the pneuoio^ 



Viewing the depressed state of the decarbonising 
power of the lungs^ as .an important pathological 
condition ; we would be especially cautious in ad« 
ministering to a Cholera patient in a state of col- 
lapse^ such remedies as are known to have a direct 
effect in diminishing the quantity of carbon evolved 
by the lungs during respiration : among the most 
powerful of which agents we find mercury ; ardent 
spirits, in such quantity as to produce a stupifying, 
in contradistinction to their exMarating and ex- 
citing effect, and the abstraction of blood. 

Facts coincide with the above observations ; and 
J know of no case of pvre cange$iiv€ or blue Cho^ 
Urn, without febrile or inflammatory S3rmptoms ; in 
which mercury does much good : in such cases, 
stupifying quantities of spirituous stimulants, like 
stupifying doses of opium, decidedly hurry on the 
fatal event; and indiscreet use of the lancet has 
certainly in some cases shortened life. Although 
this view of the subject is here alluded to, in hopes 
that its legitimate application to practice may here^ 
after undergo the strictest examination and experi-f 
mental investigation : I may state that I have, in 
very bad cases of the low form of Cholera, been so 

far 



CHOLERA. 37 

gastric nerves. The most undeviating 
phenomena pf Cholera attended with 
early collapse, are the recession of Wood 
from the surface of the hody, and its 
accumulation in the great veins of the 
abdomen and thorax ; a gorged state of 
the capillary vessels of the lungs ; and 
disordered secretion from the mucous 
membrane of the intestinal canal : at the 
same time that the mucous membrane 
of the bronchial tubes and cells of the 



& influenced by these considerations^ as to abstain 
from the free use of calomel, to stimulate with 
ammonia^ and to use only small quantities of spirits 
or brandy^ trusting to the warm resinous purga- 
tives^ given alternately with castor oil^ and enemas : 
enjoining tranquillity^ and supporting the system 
by mild farinaceous food in small quantity. The 
result has been satisfactory ; the pulmonary system 
has resumed its healthy action^ and ultimate reco« 
very followed in the most favourable manner; 
without the appearance of black stools. Cautious 
trials of this sort^ on a large scale, are requisite, 
before we can be authorized in recommending the 
general employment of such a practice. 



38 CHOLERA. 

lungs, occasionally has its secretion af- 
fected in a similar manner, though to a 
slighter degree. 

In cases not fatal^ the progress of re* 
covery is often almost as rapid as the 
accession of Cholera ; and if the disease 
be promptly treated at the very onset, it 
is not uncommon to see a person well 
on the third day after the attack of the 
worst symptoms, ^which had commenced 
with coldness and collapse ; and who, if 
left without remedies, would probably 
have died in six or eight hours. In these 
instances, recovery seems almost as sud* 
den and complete, as in cases of suspen- 
sion of animation from submersion in 
water. 

We see a person suddenly attacked 
with vomiting, and purging of cholera- 
stools, he quickly becomes cold and has 
a rapid feeble pulse: we know that if 
left to the course of nature, or supplied 



CHOLERA. 39 

inih a few glasses of cold water, this pa* 
tietit will be in a hopeless state in a few 
hours ; whereas, if he get a table spoon* 
All of tincture of rhubarb undiluted, or a 
teaspoonful of laudanum, and as much 
spirit of sal volatile, in an ounce of 
water ; immediately on the first attack, 
the disease is very often at once arrested. 

Many of the febrile cases, especially 
those where there is a dry tongue and 
feverish flush of the face, are slower in 
arriving at complete convalescence ; and 
we have occasionally sufficient evidence, 
Ihat, besides the disordered functions, 
and congestion with incipient inflamma- 
tion, of the early stage ; there is a de- 
tjided tendency to a slow inflammatory 
t^ondition of several internal organs, at 
demote periods. When reaction com- 
mences, it is irregular, and I have seen 
one eye suffused with bright arterial red- 
ness, while the other eye was pale. 



40 CHOLERA. 

Patients who remain without pulse at 
the wrist above three hours, seldom 
survive the attack; though we sometimes 
succeed by means of ammonia, camphor, 
assafoetida, and small quantities of opium, 
combined with warm resinous purgat 
tives ; and some stimuli of spices, wine, 
or spirits ; to resuscitate the pulse, and 
restore the warmth of skin, in persons 
who have been a whole day cold and 
without pulse at the wrist. Yet the ma- 
jority of those so excited, ultimately ex- 
pire, after lying a longer or shorter 
period, sometimes several days, in a half- 
torpid state, without either spasms of 
purging : while in this state they suffer 
much nausea, and continue to vomit 
whatever fluid is drank; gulping up 
every eight or ten minutes, almost with- 
out effort, large mouthfuls of yellowish 
green bile, which is spat over the bed- 
clothes and floor, without moving the 
head. While this condition lasts, an 
attempt to sit up in bed causes faintness^ 



CHOLERA. 41 

This is almost as hopeless a condition as 
a Cholera patient can fall into : in cases 
of this sort, free blood-letting, or an 
active purgative is apt to sink the pa- 
tient irrecoverably : stimulants excite 
fever, and hurry on the fatal termination. 
By whatever mode these cases are treat- 
ed, the most intense gastro-enteritis is 
found after death, and the intestines are 
loaded with superabundance of bile and 
dark-coloured secretions. A few recover 
by the cautious application of leeches, 
as soon as the patient will bear them 
without sinking the pulse ; repeated use 
of moderate V. S. is often requisite in 
the latter stage of these cases; and per- 
severance in a steady course of resinous 
purgatives; with the mildest food in 
small quantities, supplied in succession 
to the first eflFects of each purgative. An 
emetic, and particularly a sulphate of 
zinc emetic, is sometimes found in such 
cases, to produce the most beneficial 
change. In other cases resuscitated by 



42 ctioLtiikA. 

stimulantS) after long continued collapse^ 
as above stated ; a febrile condition fol- 
lows, with frequent weak pulse, and 
lurid redness of face, resembling the 
remote stage of bad cases of remittent 
Fever. 

The fatal termination of Cholera, in 
some of the most sudden cases commenc- 
ing with extreme collapse ; seems to de- 
pend on the intensity of the efficient 
cause of the disease, acting so power- 
fully on the nervous system as to pro- 
duce total arrest of all vital energy ; and 
death, as it were by suspension of ani- 
mation ; cessation of vital actions taking 
place, with hardly any preliminary course 
of disease. 

Many others die from venous conges- 
tion, with a remarkable stagnation of the 
blood in the great veins of the internal 
parts of the body, and cessation of most 
of the secretions; combined with a less 



CHOLERA. 43 

de^ee of that sort of shock of the ner- 
vous system, which produces the sudden 
termination just described. 

The fatal event at a still later period, 
has more or less of local inflammation, 
superadded to congestion ; and combined 
with the remains of such disorder of the 
nervous system as in its more intense 
degree causes early death. 

While a rapid and weak pulse conti- 
nues, though there be not much purging 
and vomiting, the patient must be deem- 
ed in the utmost danger. 

The severer cases of Cholera, with 
early coldness and collapse, tending to 
sudden death without reaction, have been 
already alluded to ; and the absence of 
inflammation of the stomach and intes- 
tines, in many of those cases, has been 
pointed out The peculiar nature of 
that description of Cholera, is . still more 



44 CHOLERA* 

remarkable, when we observe the same 
stage of that disease attacking dysenteric 
patients who had been for many days 
voiding bloody stools ; but who, on being 
sei2:ed with Cholera, cease to void blood, 
and their evacuations change to the fluid 
resembling rice-water ; examples of which 
were seen in the cases of Cox, and Post, 
which are mentioned in this chapter: 
aflfording evidence of the fact, that the 
circulation in the capillary system of 
yiessels of internal organs in the febrile 
Cholera, is in a state totally different 
from what takes place when the Cholera 
with sudden coldness and early collapse 
comes on ; and when in fact the essential 
character of the disease consists in accu- 
mulation and stagnation of blood in the 
veins, and principally in the great inter- 
nal veins. Robust and plethoric subjects 
suffering from this form of disease, also 
exhibit strong marks of stagnation of 
blood in' the smaller cutaneous veins; 
affording the appearance which has been 



J 



CHOLERA* 45 

denominated the blue Cholera: a state 
of disease often existing in the most in- 
tense degree, when totally void of inflam- 
mation. 



Morbid Appearances on Dissection. 

The appearances observed on the in- 
spection of subjects that have died of 
Cholera, are various ; according to the 
nature and duration of the illness^ and 
the circumstances that have preceded 
and accompanied the attack. In the 
damp hot climate of Bengal, we are 
obliged to perform our dissections at an 
early period after dissolution, generally 
from three to twelve hours. And it has 
frequently occurred to me to observe, 
that bodies are warm for some hours 
after death, although the persons, while 
suflFering under Cholera, had been exr 
ceedingly cold for several hours, and 
sometimes more than a whole day, before 
they died. The exterior of bodies after 



46 CHOLERA. 

death from Cholera, is generally found 
livid from the stagnation of venous blood 
in the capillaries, especially about the 
chest and neck : and still more so at- 
those parts which are dependent, and 
liable to be discoloured by the gravitation 
of blood. The muscles are generally 
rigid, of a lurid red colour : and robust 
subjects are seldom emaciated by those 
attacks of Cholera which are fatal after 
a short period of illness. But even in 
these, the eyes are sunk deeply into the 
sockets, and the fingers, hands, and feet^ 
remain shrivelled. In a few weak and 
emaciated subjects, the surface is whiterv 
and corrugation of skin more extensively 
visible. 

The most common morbid appear* 
ances in the viscera of those who die 
after an illness of only a few hours ; are a 
pale colour of the stomach, when viewed 
externally ; a thickening of its coats, so 
as to feel like a thick new doe-skin glove; 



CHOLERA. 47 

its interior is also sometimes quite pale, 
but generally of a pink colour, in patches 
of various sizes and covered with a thick 
tenacious viscid mucous secretion. The 
mucous membrane of the stomach is 
often much corrugated into longitudinal 
folds ; and when its secretions are seen 
not tinged by medicines, they are usually 
at this stage of the disease, a pale«grey 
water : frequently the stomach is relaxed, 
and this secretion is then in very large 
quantity. The small intestines of a pale 
pink colour, that in many cases could 
hardly be deemed morbid, their coats 
thickened and pulpy, as if oedematous, 
the villous coat sometimes quite pale : 
their contents usually consisting of a 
whey-like fluid, and a thick curdled 
mucus, in various proportions* More 
rarely we find the small intestines loaded 
with quantities of a substance resem* 
bling a thick paste of flour and water, 
and occasionally there is a fluid like dirty 
gruel, or like the sediment in bairley-* 



48 GttOLERA. 

water. The great intestines at this stage 
of the disease, are of a pale bluish co- 
lour, with little or no vascularity, their • 
coats frequently remarkably thin; con- 
tents, copious^ arid watery, or like rice- 
water in which some films of mucus are 
floating. The great portal and mesen- 
teric \eiiis and the cavae, turgid with 
blood. Liver and spleen usually tumid 
from venous congestion, especially if the 
subject be plethoric. The gall-bladder 
is found to contain bile of various shades 
of green, usually somewhat inspissated, 
but frequently appearing in a healthy 
state. In a few emaciated subjects, 
where the »ater, purging had been ver^ 
profuse during life, and the extremities 
remained much corrugated after death; 
the peritoneal coat of the abdominal vis- 
cera was sometimes dry, and not covered 
with the usual lubricating serosity ; the 
whole of the viscera seeming shrunk and 
bloodless. The cavities of the heart are 
usually distended with black blood. The 



€HDLERA. 49 

lungs generally exhibit a degree of ve- 
nous congestion, which, at the depending 
parts, is much increased by gravitation. 
The bronchial tubes in some cases filled 
with frothy fluid ; in others, lined with 
a tenacious mucus of a very viscid de- 
scription^ which when scraped off and 
collected, resembled a thick paste of 
wheaten flour. This latter appearance 
usually found in cases where the voice 
had been feeble and pectoral, and it is 
certainly more commonly met with in 
the cold season: suppression of voice 
occasionally occurs when this morbid 
bronchial secretion does not exist. Ve- 
nous congestions in the brain and spinal 
marrow, inconsiderable in emaciated sub- 
jects ; but remarkable in those who were 
plethoric. Bladder contracted, generally 
contained about two ounces of limpid 
urine; and a small quantity of white 
mucus can be seen on its internal surface. 

The above morbid appearances of the 

D 



50 CHOLERA. 

viscera, in cases of Cholera proving ra* 
pidly fatal ; are supposed to be the vestiges 
of a much higher scale of vascular tur- 
gescence during life : but this is doubtful. 

When the patient has lived longer, and 
Cholera has been attended with violent 
and painful spasms ; but more especially 
when a prolonged disease has been mark* 
ed by any febrile symptoms, the conges- 
tions above described, are attended by 
distinct appearances of inflammation of 
the small intestines. The omentum, me* 
sentery, and mesocolon, present a high 
degree of morbid vascularity : the mu* 
cous membrane of the stomach is more 
extensively and more highly coloured 
with red, and this is often the case when 
on examining the exterior of the sto- 
niach, it is still pale and its coats much 
thickened. In more advanced stages, 
the coats of the small intestines are found 
thin and diaphanous, so that masses of 
viscid mucus, deeply tinged with green 



CHOLERA. 51 

bile j may be seen before opening the 
gut ; and in these cases there is usually 
much flatus in the small intestines, with 
some pale-grey fluid. Proceeding to 
speak of those who have survived to the 
third or fourth, or fifth day ; inflamma- 
tions of the intestines are more distinct 
and extensive : the small intestines are 
then found to contain quantities of viscid 
mucus of various colours, and green bile ; 
the large intestines filled with dark-grey, 
dark*brown, or black thin fluid. The 
morbid appearances in the ulterior stages 
of febrile Cholera, very much resemble 
those seen in the dissection of subjects 
who have died during the remote stages 
of remittent Fever. 

Some of those in whom the disease 
begins with early sinking and deadly 
coldness, survive that stage for two or 
three days; having a slight degree of 
lurid redness of face, with ineffectual re- 
action of the system, marked by retum- 

d2 



52 CHOLERA. 

ing warmth of skin and improved state 
of the pulse; but they are inclined to 
faint. when in; the erect posture: such 
cases are often fopnd to sink into a state 
of stupor, and die on the fourth or fifth 
day. Dissection then shews . much venous 
congestion of the braiti, still more of the 
lungs ; and a general^ lurid redness of 
the ^mall intestines, which approaches to 
a mahogany colour ; but sometimes no 
congeries of minute vessels is to be seen: 
we are .inclined to speak of this state ; as 
mortification of the muscular fibres of 
the intestine^ for the intestines are very 
easily torn. In such cases, their con- 
tents are mostly a thin chocolate-coloured 
fluid. The coecum usufkHy strongly mark-, 
ed by the lurid appearance of its coats^ 
which are thin. 

When febrile and spasmodic symptoms 
have predominated, we occasionally find 
intus-susceptions in the small intestine, 
and still more frequently portions of the 



CHOLERA. 53 

t^^nal contracted to the size of the little 
finger : the contracted portion of intes- 
tine sometimes red, but more commonly 
paler than the rest. I have very often 
seen a contraction at the sigmoid flexure 
of the colon, of a foot in length, without 
any morbid vascularity at that part ; the 
mucous membrane at the constricted part 
exceedingly corrugated and almost dry. 
Lumbrici are occasionally found in the 
intestines. 

In the dissections of Cholera subjects, 
T have sometimes met with morbid ap- 
pearances, which would not seem essen- 
tially the result of the disease ; and they 
probably have been influenced by cir- 
cumstances in which the patient was 
placed prior to^ or during the commence- 
ment of the attack. In the post-mortem 
examinations of sailors who were seized 
by Cholera in the Bazaars, where they 
had been much exposed to the sun, and 
in habits of dissipation ; a considerable 



54 CHOLERA. 

serous effusion has been found between 
the arachnoid and pia mater, over the 
whole convex surface of the brain ; and 
frequently there is serous effusion in the 
spinal canal. The same appearances 
have been observed in sober people, in 
whom Cholera came on after much ex- 
posure to the sun, and proved fatal. 
These patients have generally soon sunk 
into a torpid condition, without much 
suffering from spasms : they quickly be- 
came cold, and died within fifteen or six- 
teen hours after the attack commenced. 
The sailors of the H. C. ship Bridge'- 
water ^ were exposed to severe privations 
and much hard work, during a succession 
of gales of wind on the homeward voyage 
from China ; and the ship was so much 
injured that she was brought to Calcutta. 
Soon after the crew landed, in June 1 830, 
many of the men were attacked with 
Cholera, which quickly proved fatal to 
several of them. On dissection, serous 
efiusion was found on the hemispheres 



CHOLERA. 55 

of the bnun ; and in some of ihe cases, 
a large quantity of serum in the lateral 
ventricles. On several occasions, when 
ships in coming up the river in the rainy 
season, have got agrotind, or lost their 
anchors, whereby the crew have been 
obliged to work hard, and were much 
exposed to the weather, and probably at 
the same time living irregularly : the sai- 
lors have been attacked with Cholera ; 
the peculiarities of which consisted in 
the patients having in several cases tym- 
panitic distension of the belly, cold hands, 
and hot feet. On dissection, acute in- 
flammation of the colon was found, be- 
sides the other morbid appearances com* 
mon in Cholera. 



Causes of Cholera. 

The cause of the more frequent ap- 
pearance of Cholera for some years past, 
is unknown; and we are unacquainted 
with any circimistances which are sure to 



56 CHOLERA. 

produce the disease, or by avoidance of 
which, residents in India can be certain 
of always escaping its attack. Cholera 
occurs at all seasons of the year, and un- 
der all circumstances : people who live 
in the best houses, avoiding excesses of 
every sort, and who are exempt from 
any species of privation ; are occasion- 
ally liable to be seized with the worst 
forms of this malady. However, we 
have abundant proof that the disease 
prevails most, among those who reside 
in low and ill-ventilated situations, ex- 
posed to humid atmosphere and sudden 
changes of weather ; who are frequency 
using ill-cooked or bad food ; and who 
indulge in eating cold or unripe fruits ; 
more especially if they be at the time 
exposed to fatigue and unusual priva- 
tions. People with impaired constitu- 
tions, or who are in a state of debility 
from any cause, are more liable to Cho- 
lera than the robust and healthy : and 
it is certain that persons recently arrived 



CHOLERA. 57 

from Europe, are very liable to an attack, 
if the disease happen to prevail at the 
time in the vicinity of their residence. 
The depressing passions, doubtless have 
much effect in rendering people more 
liable to an attack of the disease. 

Sudden decrease of temperature ap- 
pears to be among the most frequent 
exciting causes of Cholera ; for we find 
it has commenced generally between two 
and five o'clock a.m. when the cold damp 
air is most sensibly felt in this country. 
Men are often attacked soon after expo- 
sure to rain, when they are fatigued; 
and many awake ill with cramps and 
other symptoms of the disease, after 
having slept in damp clothes. Soldiers 
on fording a river early in the morning, 
though the water be not a foot deep, are 
apt soon to fall ill, especially if they have 
marched several miles previously, so as 
to be heated and fatigued before they 
pass the ford : and they are often at- 

D 3 



58 CHOLBEA. 

tacked in the night, or early in the morn* 
ing, after encamping on the low damp 
bank of a rivulet. Hard work, and ex* 
posure to the sun and rain alternately, 
seem occasionally to bring on the dis* 
ease : and a large dose of saline purga- 
tive has frequently excited an immediate 
attack. When three or four severe cases 
of Cholera have happened about the 
same time, at different parts of the town; 
we know that any man who takes an 
active saline purge, is very likely to fall 
quickly into a state of Cholera with col- 
lapse. Severe cases of Dysentery, or 
even slight DiarrhcBas, are apt in the 
most sudden manner to lapse into the 
low form of Cholera ; at those times 
when the latter disease is prevailing in 
the vicinity. Drunkenness has been fol- 
lowed by a severe form of the disease 
among large numbers, as happened in 
H.M. 14th Regiment, in 1828, at Ber- 
hampore ; where, after a distribution of 
15,000 Rupees prize-money to the sol- 



CHOLERA. 59 

diers of the Regiment ; ninety-four cases 
of Cholera appeared within a few days, 
of whom twenty died. Of these ninety* 
four patients, forty-five had been from 
nine to fourteen years in India. Never- 
tiieless, at corresponding periods, in other 
years, we often see patients vomiting 
violently for hours, and others are purged 
profusely for several days, without Cho- 
lera coming on : intemperance to the ut- 
most extent, exposure to atmospheric 
vicissitudes^ and all the other exciting 
causes* above enumerated, often exist to 
an extreme degree, and the disease does 
not follow. Therefore we must acknow- 
ledge that some other cause or circum- 



* The same observation may be made with res- 
pect to many other diseases which .are influenced by 
atmospheric vicissitudes. We cannot give any rea- 
son why exposure to sudden changes of tempera- 
ture^ in England^ causes Rheumatism to prevail in 
one year ; Ophthalmia in another 5 Catarrhs in a 
third ; and Fevers in a fourths 



60 CHOLERA. 

stance, is essential to the production of 
Epidemic Cholera; since we see that 
these circumstances which seem to be 
efficient in exciting an attack in one 
year, are not productive of the disease 
in the next. The disease has been 
ascribed to some unwholesome condition 
of the atmosphere, which we have ho 
means of appreciating, except by its 
eflFects ; as we judge of the presence of 
malaria, in the case of intermittent Fe- 
vers. We know that at times everv 
slight ailment seems convertible mt^ 
Cholera of the most rapid and fatal des- 
cription ; among the inhabitants of a sta- 
tion where the disease had not previous- 
ly existed, and where it cannot be traced 
to the arrival of sick persons, or to any 
mode of imported infection : the disease 
appearing about the same time at various 
and remote parts of the town, among 
persons of the most opposite habits of 
living, who have no direct or indirect 
communication with each other ; as was 



CHOLERA. 61 

the case in Calcutta in 1830, and on 
several other occasions. Strangers com- 
ing to a town when a general proclivity 
to Cholera exists, must be very liabFe to 
the disease ; if they happen to arrive 
after suflFering fatigue and privations, 
and just when the local distempered 
state of the atmosphere, with the usual 
exciting causes, are about to affect the 
residents of the place. Persons arriving 
at such a time, with any disorder of the 
digestive organs, may become the first 
sufferers ; and thus the probability of im- 
ported contagion is suggested : though a 
strict investigation of the circumstances 
in detail, may be sufficient to negative 
any idea of contagion. 



Treatment. 

In the treatment of Cholera, it is of 
the utmost importance that remedies be 
employed early ; and that they be varied 
with careful reference to the nature of 



62 CHOLERA. 

the attack, and the existing stage of the 
disease : for the utmost vigilance and dis- 
crimination of the practitioner are often 
defeated. The cases which will presently ^ 
be adduced, as well as the various ac^ 
counts previously published in Bengal, 
shew us a great class of diseases to which 
the name Cholera has been applied. The 
whole of these have more or less of a 
common character so distinctly marked, 
that we rarely hear of a difference of 
opinion among practitioners concerning 
the identity of the disease : and still in 
some of the individuals of this class we 
find the prevailing tendency of the com- 
plaint, not only different, but diametri- 
cally opposite to what constitutes its 
predominant character in other cases. 
If the diseases which are acknowledged 
to be Cholera, were so ranged on a scale 
as to place those cases which have most 
affinity together ; and those most dissimi- 
lar, at a distance: we should find one 
end of this scale occupied by diseases in 



CHOLERA. 63 

which the actions of the conBtitution are 
distinctly febrile, and in many of them 
the evidence of local inflammation is 
strong and unequivocal, as in the most 
intense examples of gastro-enteritis. At 
the other extreme of this scale, we should 
find the prevailing characters of the dis- 
ease, as already stated, consisting in 
coldness, depression of vital actions, and 
extreme venous congestion; w^th ten- 
dency to sudden death, not preceded by 
much active disease. Between these 
two extremes, every possible variety ex- 
ists : the disease with early collapse and 
coldness, generally combines an intense 
degree of congestion of blood in internal 
organs, with some remote tendency to 
inflammation of the intestines, and some- 
times (though rarely in Bengal,) of the 
brain : while the febrile cases, and those 
which are marked by distinct evidence 
of local inflammation ; are by no means 
void of congestion, and they frequently 
lapse suddenly into the low state, with 



64 CHOLERA. 

coldness, and the most awful prostration 
of vital power. Our watchful attention 
to the course of the disease is urgently 
demanded, on account of this occasional 
tendency to sudden change ; lest we be 
misled, and induced to use depletion, by 
V. S. or other means, at a time when 
such treatment may be injurious. It will 
be evident that the treatment of Cholera 
must be varied according to the nature 
of the disease. 

In the febrile and inflammatory stages 
of the disease, attended with violent and 
painful spasms, warmth of surface, and 
free circulation; our chief dependance 
must be on V. S. leeches, and purgatives 
of calomel or blue pill, with cathartic 
extract; alternated with castor oil ; in a 
few of these febrile cases, we may ven- 
ture on jalap and scammony at more re- 
mote periods of the disease. The earlier 
a case of Cholera of this description is 
bled, the more certain and effectual is 



CHOLERA. 65 

the relief which is obtained. While those 
patients, who come under treatment at 
a late period of the disease ; even though 
distinctly marked inflammatory symp- 
toms be present ; require great caution 
in the employment of depletion, and still 
they are almost certain to die without 
antiphlogistic treatment. Opium is ad- 
missible for one or two doses, in small 
quantity, at the onset of these febrile 
cases ; when watery evacuations prevail : 
but except for the purpose of allaying 
the dreadful commotion of the system, 
and to arrest profuse purging ; we derive 
little benefit from this remedy. Nothing 
relieves the spasms of the early stage of 
febrile Cholera, so effectually as the lancet. 

There is a more remote stage of the 
disease, in which local inflammations 
take place ; appearing sometimes to be 
excited by premature return to a diet of 
animal food, and in other cases to arise 
without any evident cause; we are 



66 CHOLKRA. 

obliged then to use the lancet, and to 
purge the patient freely, as in an ordinary 
inflammatory fever. At the same time, 
a word of caution is requisite ; lest the 
inexperienced practitioner, should mis- 
take Cor fever or inflammation, the tran- 
sient and ineffectual re-action which often 
occurs just before death : attended with 
morbid heat of forehead and chest, while 
the patient is torpid, blue, and restless ; 
as vain attempts have been made to cure 
these cases by bleeding. The least that 
can be said of such treatment, is to 
acknowledge its total inutility. 

Where the evacuations have been pro-- 
fuse, it is always advisable to give a 
small quantity of thin sago, or arrow- 
root ; as soon as the stomach will retain 
it; and the employment of a small 
quantity of food of this sort, need not 
interfere with the general antiphlogistic 
plan above stated. 



CHOLERA. 67 

The majority of these febrile cases, 
can generally be saved; if seen early 
and treated with careful discrimination 
and perseverance. 

In the low description of Cholera, 
where the vital actions fall early into a 
state of torpor and collapse, with profuse 
cold perspirations ; we have a much more 
formidable complaint -to contend with. 
There is but little time for consideration 
in this form of the disease ; it is rapid 
in its course, and deadly in its tendency : 
the most judicious measures that can be 
adopted, too often fail. It is necessary 
in the first instance to uphold the feeble 
remains of vital energy, and as it were 
to resuscitate the patient, otherwise the 
susceptibility to remedies is speedily 
extinguished. For this purpose, it is 
necessary to give some opium with sti- 
mulants. If the patient be seen early, 
and the vital actions have not been very 
much sunk; half a grain of opium with 



68 choleha. 

six grains of blue pill should be given 
every half hour, while frequent purging 
continues ; and two ounces of hot sago 
with one ounce of brandy may be taken 
after the second dose of the pills. In the 
early stage of those cases where Cholera 
symptoms have supervened suddenly oii 
diarrhoea; we often see patients whose 
tongues are cold, the eyes sunk, and 
prostration extreme, entirely altered in 
two or three hours; warmth being re- 
stored ; and we have to manage diar- 
rhcBa with slight febrile symptoms. But 
after a few hours' continuance of the 
disease; when the pulse becomes low 
and weak, and the voice feeble, it is 
necessary to use more active remedies ; 
at the same time, we must alwavs bear 
in mind the possibility of overpowering 
the system, eitlier by opiates or spiri- 
tuous stimuli, when the vital actions are 
sinking into a low and feeble state. I 
have seen in these cases, prompt and 
effectual relief more frequently afforded 



CHOLERA. 69 

by opium than by any other remedy. 
But when this medicine is likely to do 
good, all the benefit derivable from it, 
follows quickly after taking one or two 
doses ; and it is more appropriate in 
those cases attended with profuse watery 
purging, than in others. Two grains of 
opium in a pill, sometimes arrest the 
most formidable symptoms. In other 
cases where the pill is immediately re- 
jected; the same quantity of opium dis- 
solved in cinnamon water, and mixed 
with 3 i. of Spirit of Sal Volatile proves 
effectual. It is advisable to make the 
patient drink a cup of hot sago, with 
some brandy or wine, as soon as the more 
distressing symptoms are moderated. If 
this be retained, and tranquillity with 
sleep follow, we may entertain hopes of 
recovery. 

Under less favorable circumstances, 
where our early remedies do not produce 
such immediate benefit ; the vomiting 



70 CHOLEnA. 

and purging are either arrested, or 
having been from the first less urgent ; 
we find the lowness and coldness not 
removed. The thirst is extreme, pulse 
feeble and 120, or more frequent; while 
a weak pectoral whining voice, indicates 
the impaired function of the respiratory 
organs, and inward distress of the patient. 
In such cases, repetition of opium is apt 
to stupify the patient, without eflFecting 
any other purpose ;* and spirit? too 
often seem to overpower him, and render 



* I consider Ammonia the best internal stimulant, 
in cases of approaching torpor^ where repeated 
doses are requisite ; it is more effectual, and safer 
than either opium or brandy. I have also tried 
Enemas of four^ and six pints of hot water, con- 
taining Ammonia in solution; with the view of 
stimulating the system^ and at the same time of 
washing away from the great intestines^ the tena- 
cious paste-like secretion^ which they contain. 
These Enemas were employed only in the most 
hopeless cases^ when other stimuli had failed; 
therefore they were generally unsuccessful. 



CHOLERA. 7 I 

recovery more hopeless. Liquor Am- 
moniac Puras is the best stimulant in such 
cases : I have given 3 i. every hour in 3 
iiss, of water, for eight doses ; and after- 
wards every two hours, until the circu* 
lation has been restored, arid warmth of 
surface has returned. An infusion of 
Cayenne Pepper may be made in the 
proportion of 3 ii. to a pint of boiling 
water, and a table-spoon&l given every 
half hour, alternately with the Liquor 
Ammoniae. If the patient be calling 
aloud for drink ; instead of giving brandy 
and water in such cases, I prefer letting 
him have an infusion of pepper, or 
ginger, either of which is to be made in 
the proportion of 3 i. to the pint of 
boiling water ; and a wine-glassful may 
be allowed every half hour, either tepid 
or cold, as the patient likes. 

• 

While these internal stimuli are used ; 
much benefit may be derived from ex- 
ternal applications. European flour of 



«v 



72 CHOLERA. 

mustard is to be mixed with hot water, 
and when made to the consistence of an 
ointment, about one-eighth part of 
common salt added: this is spread on 
calico; and applied to the epigastrium 
and across the lower part of the chest, 
and to the spine, and feet. If the skin 
retain any degree of susceptibility, this 
will soon act as a strong rubefacient, 
and when left on for five or six hours it 
blisters. I prefer this to any other ex- 
ternal stimulant : after having tried Tur- 
pentine, common Blisters, and boiling- 
water, as well as pure nitric acid ; and 
in extreme cases, the red hot iron has 
been applied to the epigastrium and 
spine. The mustard plaster is not so 
irksome to bear as a blister, and it is free 
from the appearance of cruelty and 
harshness, which is an objection to some 
of the other stimulants just named. 

If Me are so fortunate as to arrest the 
progress of symptoms threatening sud- 



CHOLERA. 73 

den death, the patient generally sleeps 
for some hours. The subsidence of 
urgent symptoms, should make us 
satisfied to wait for three or four hours ; 
and then we must give mild aperient 
medicine every four hours, until the 
bowels are made to act moderately. For 
this purpose, castor oil should be given 
every eight hours ; and in the intervals 
12 grains of compound extract of colo- 
cynth, with six grains of blue pill, and 
two grains of aloes. If a tendency to 
the low stage of the disease still pre- 
dominate; I would give only half the 
above quantity of blue pill, and would add 
two drops of cinnamon oil, or of the oil of 
peppermint to each dose of the pills. 
Supporting the patient with sago, arrow- 
root, or other farinaceous food; and 
giving wine in small quantity, or omit- 
ting it according to the indications of py- 
rexia, or local inflammation. 

After patient begins to recover from 

£ 



74 CHOLERA. 

the stage of collapse ; the disease seems 
to balance between a return of the 
lowness; and the accession of Fever 
with inflammation : the fonner condition 
is the most to be dreaded; it may be 
brought on by cold drastic purges, un- 
timely bleeding, copious draughts of cold 
water, or imprudent exertion in at- 
tempting to rise to stool. After all that 
can be effected, by diligence and science ; 
it must be acknowledged that a large 
proportion of Cholera cases which sink 
into the state of collapse, are then in- 
evitably fatal. 

The domestic management, and ac- 
cessories to the medical treatment of 
Cholera patients, are very important. 
The sick person should be placed in an 
airy room, on a low and rather narrow 
bed; that he may be easily and effectually 
assisted: the room should not be 
crowded with attendants, nor should the 
patient be left in a draught of air, but 



CHOLERA. 75 

the face may be fantted. If profuse per- 
spirations exist; the surface should be 
frequently rubbed dry, with hot flannel ; 
but the whole body need not be uncovered 
at one time, for this purpose. During the 
low form of the disease with decrease of 
natural warmth; the patient should be 
placed between blankets, and the extre- 
mities diligently rubbed and champoed 
by attendants, whose hands are frequently 
warmed. Tin cases made to hold hot 
water, or bottles of hot water, or bags of 
hot sand, are frequently placed by the pa- 
tient's limbs : but restlessness of the sick, 
renders these means of affording artificial 
warmth, generally of little avail. It is 
proper to prevent patients from rising to 
stool, so long as there is any appearance of 
collapse, with lowness and frequency of 
pulse : and under any circumstances, while 
copious watery evacuations continue fre- 
quent, it is desirable to make the sick 
remain recumbent, and use a bed-pan. I 
have many times seen men rise to stool ; 

E 2 



76 CHOLERA. 

and after a copious gush of watery eva- 
cautions from the bowels ; to fall on the 
floor, sometimes apparently fainting, 
at other times convulsed : some of these 
have died within five minutes after 
rising to stool, who had not been 12 
hours ill, and who had some degree of 
warmth of surface at the time of getting 
out of bed ; having just before that been 
speaking rationally, though in a state of 
anxiety and restlessness. When the pulse 
at the wrist has ceased, .or is very feeble 
and rapid, the patient anxiously tossing 
about in his bed, and when entire arrest 
of the circulation seems impending; any 
exertion of the patient is likely to prove 
injurious: either rising to the erect 
posture, or sitting up in bed, should then 
be prohibited. The most precise in- 
structions to the attendants, are requisite, 
regarding the quantity of drink, or 
aliment to be given: for although a 
wine-glassful of some drink may be al- 
lowed, (to any patient in whom it does 



CHOLERA. 77 

not quickly excite vomiting,) and in 
febrile cases, may be repeated every 
hour ; a free use of fluids, is almost 
always injurious.. 

The following cases, are intended to 
shew the nature of Cholera in Bengal ; 
and the effects of the treatment. 

Those in which a febrile or inflam- 
matory condition existed, are arranged 
first in order ; though that form of the 
disease is not always the most frequent 
in this part of India. After these are 
placed, some cases in which it would 
appear that V. S. was injurious, and 
others in which it was useless. Then 
follow some examples of the disease, in 
which the extraordinary venous con- 
gestion, and impeded circulation, were 
attended with such apparent agony, and 
laborious heaving of the chest, that I was 
induced to hope relief might be obtained 
by opening the radial artery ; which was 



78 CHOLERA. 

tried, and as much blood obtained as the 
most urgent advocates of blood-letting in 
Cholera; have considered sufficient to al- 
leviate the oppression. Next in order, 
are arranged cases in which the sudden 
coldness and collapse, with sinking of 
vital power, were so extreme ; either that 
blood could not be obtained from the 
veins, or the attempt at V. S. was not 
deemed advisable; and therefore the 
patients were at first treated by opium 
and stimulants. These examples, will 
prove that no exclusive rule of practice 
can be followed ; and that the utmost 
diligence and discrimination are re- 
quisite ; to apply such remedies as are 
best suited to the nature of -the attack, 
and U.e existing s«ge of the di«,.«. 

Case VI. — ^Thomas Greenwood, Mt 
21, of middle size and light complexion, 
recently landed from Europe ; was takea 
ill with purging, at noon on the 16th 
November, 1830; and he was at stool 



CHOLERA. 79 

as often as six times an hour. Cramps 
in the extremities and vomiting com- 
menced at ten o'clock on the 17th, and 
as he appeared to be getting worse, -he 
was sent into General Hospital at 11 
A.M. His pulse was then 116 and weak ; 
tongue cool and moist ; skin cool ; and 
voice feeble: there was slight arterial 
or florid congestion of the eye-balls; 
eyes only half open, but a bright light 
was not painful. 

V. S. ad lb. i. 

R. Calomel. 3 i. — Opii gr. i. in a Pill. 
R. Spirit Ammonise Aromat. 5 i* 

Aquae Tepid. ^ iss. misce. To be drank 

after the Pill. 
Extremities rubbed with Spirit of Turpen- 
tine. 

1 p. M. — Blood not buffy, the cramps 
have ceased, otherwise he is not much 
changed; he has been vomiting, and 
purged often; the evacuations are a 
clear watery fluid, with flakes of mu- 
cus. 



80 CHOLERA. 

R. Calomel. 9 i. 

Extract Colocynth. Comp. 3 sd. — to be 
taken now, in three Pills; and repeated in two 
hours. Draught as aboye^ to be repeated with 
each dose of the Pills. 

5 P. M.— Vomiting and purging con- 
tinue ; he complains of thirst ; pulse ra- 
ther more distinct; the last stool i$ 
sKghtly colored with grey faeces. 

Repeat the Pills and Draught, 

7 P. M. — ^Had one more stool, of the 
same appearance as the last ; pulse un- 
changed ; his voice is a little stronger ; 
he lies quiet and is cold, the fingers 
shrivelled ; but tongue warm. 

R. Calomel. 3 ss.— -Extract. Coloc3mth. Comp* 
Asafoetidse aa gr. v. — ^misce, fiant Pill iii. 
To be taken at 7, and repeated at 9^ 11 p. m. and 
1^ and 3 a.' m. to-morrow. 
R. Mist. Camphors lb. i. 

Sp. Lavand. Comp. — Tinct. Hyoscyami aa 
3 iss. misce. — To take two ounces «very two hours. 
A cup of hot sago with 1^ oimces Port 
Wine to be given immediately. 



CiiOLERA. 81 

itJov. IBth — He h^s had one scanty, 
slimy, pale-grey stool, and vomited often 
during the night. Pulse 1 02 and feeble ; 
tongue clean, warm, and moist ; voice 
very feeble ; has occasional slight cramps 
in the legs. 

R. Calomel. 3 ss.-— Extract. Colopynth. Comp. 
gr. y. — misce^ fiant Pill ii. To be repeated every 
three hours, with some of the Camphor mixture. 
Apply a small blister to the Epigastre. 
Let him have Port Wine^ three ounces, in 
some hot sago. 

Vesper, — He has taken five doses of. 
the pills ; has not vomited, and had no 
stool : cram.ps have ceased, and the 
shrivelled state of fingers has disap- 
peared. 

Enema Purg. statim. 
R. Extract Colocynth. Comp.-^9 ss. 

PiL Hydrarg. gr. v.— in three Pflls at bed- 
time* 

Nov. \9th. — Had two free dark-green 
stools at night; pulse soft' and weak ; 



8^ CHOLERA. 

he is cold, but his voice is stronger : 
tongue Avarm, moist, and slightly coated 
with white mucus. 

R. Calomel. 3 ss. 

Extract. Colocynth. Comp. 

Asafoetidae aa gr. v. To be taken at 6 a. m. 
and repeated at noon^ and at 3 p.m. — Diet^ tea^ and 
three ounces Port Wine in a cup of hot sago at 1 1 

A.M. 

Vesper. '^He took three doses of pills ; 
vomits often ; is colder and very thirsty ; 
tongue cold. These unfavourable ap- 
pearances are ascribed to his having 
drank much water, and tea; which he 
obtained contrary to orders. An at- 
tendant was directed to prevent his 
drinking. 

R. Calomel. 9 i. 

Extract. Colocynth. Comp. B ss. 
Opii. gr.^ S3* To be taken in three pills, at 
6, and repeated at 10 o'clock. 

Nov. 20fA.— No stool, and very little 
change in any respect. Pulse low, weak, 



CHOLfiRA. B3 

and soft ; tongue not quite cold ; he 
suffers from anxiety. 

Habeat Enema Purg. statim. 
R. Calomel. 3 i. — Extract. Colocynth. Comp. 

B ss. 
In pills at 7 A. M. and repeat at noon. 
Give some hot sago with brandy, at 11 

o'clock. 

Vesper. — Had three stools, the last 
was black, feculent, and fluid. He is 
warmer ; pulse improved. Has not vo- 
mited ; the gums are sore. 

R. Extract. Colocynth. Comp. — Pil. Hydrarg. 
aa gr. V. 

10 P. M. — He has had several free 
fluid stools ; and is weaker. 

Habeat statim Enema. Purg. 
R. Pil. Hydrarg. gr, vi.— Opii gr. L fiant pil. 
statim sumend. 

Nov. 21 St. — He has had several black 
fluid stools, since last report: he is now 
warm, and rather better; but there ap- 



84 CHOLERA. 

pears some lurid congestion of the face ; 
pulse soft and low, 

R. Extract. Colocynth. Comp. 
Pil. Hydrarg. aa gr. v. at 6 a. M. 
OL Ricini, J i. at noon. 
Diet— Tea, Breads and Sago. 

Vesper.— H^d four free, dark, feculent 
stools; has not vomited, pulse more 
distinct, and he is much stronger and 
better. 

After this a slight feverish disposition 
remained a few days; he took a mild 
purgative daily, and gradually improved. 
Was allowed chicken and vegetables on 
the 25th, and was discharged on the 
29th November, 1830. 

Cask VII.— Stephen Drewry, JEt3I. 
A stout man, with a florid face, recently 
landed in Bengal, was seized with vomi- 
ting, and purging, and pain in his belly 
at 8 p. M. on the 21st May, 1827, but 
did not send for medical aid till daylight 



CHOLERA. 85 

next morning. He -i^as then bled to lb. 
i. had a blister applied to the epigastre, 
and took two grains of opium .in solution 
in an ounce of mint-water, with Spirit. 
Ammonise Aromat. 3 i. He was not 
seen by me till 8 a. m. on the 22d May, 
when he was brought to Hospital; he 
was then purged, and felt very weak. 
Ordered to take 

CalQmel.—Extract Colocynth. Comp. aa 

gr. v. statim. 
01. Ridni. i i. at noon. 

Fejrper.— rHad three stools, evacuations 
not kept for inspection ; ptdse 98 and 
small, but rather hard, and he is fever- 
ish. 

V. S. ad lb. i. 
R. Extract. Colocynth. Comp. 

Pil. Hydrarg. aa gr. v. in two Pills at bed« 
time. 

May 23rf.— Blood not bulFy ; he had 
four watery stools during the night, the 



86 CHOLERA. 

colour of ink. Pulse 102 and weak ;. 
there is still a slight flush of face. 

R. Calomel. 

"Entrajct. Colocynth. Comp. aa gr. v. at 7 a. h. 
Ol. Ricini. 3 i* at noon. 

Vesper. 6 p. m. — ^Had five very scanty, 
fluid, black stools, since morning ; he has' 
now pain in the lower belly, and oppres- 
sion at chest. Pulse 70, soft, and weak ; 
tongue cool, moist, and clean. 

Apply six leeches to the lower belly. 
R. Extract. Colocynth. Comp. 

Pil. Hydrarg. aa gr. v.— Opii .gr. J, to be 

taken now. 
01. Ricini. 3 i. at 8 o'clock. 

May Q4th. — He had several scanty 
green and yellow stools, and has suffered 
severely from cramps in his legs. . 

R. Extract. CQloc3mth. Comp* 

Pil. Hydrarg. aa gr. v. to be taken at 7 a. M. 
01. Ricini. 3 i. at noon. 



CHOLERA. 87 

Kejrper.— The medicine has produced 
four stools of yellowish brown colour; 
tongue cool and nearly clean ; pulse 
better ; he has some cramps in the belly 
but none in the legs. 

R. Extract Coloc3nith. Comp. 
Pil. Hydrag. aa gr. v. 

May 25th.' — Had three bilious yellow 
stools, in which many films of white 
mucus are floating. Has now pain in the 
belly, and slight morbid heat of skin. 
Pulse 92. 

Apply 12 leeches to the belly, 
ft. Pulv. Rhei. 3 i. 

- After this he took a purgative 'dose of 
rhubarb, or of colocynth and blue pill 
almost every day, and appeared to be 
improving. 

June 2d. — He was seized at one p.m. 
with violent pain at stomach, and spas- 
modic twitchings in the fingers and toes. 



86 CHOLERA, 

Pulse strong and frequent. He was bled 
to 20 ounces ; the blood on cooling was 
buflFy. 

fl. Extract Colcxynth. Comp. 9 ss. 

Pil. Hydrarg« gr, v.— Opii gr. i* misce — to 
be taken at 6 p.m. 

3d, — Pain moderated, but not remov* 
ed : a white tongue, and slight pyrexia ; 
no stool. 

Apply 16 leeches to scorb. cordis. 
Enema Furg. istatim. 
R. OL Ricini. J iss. at 6 a. m . /md repeat at 
noon. 

Six leeches were applied on the 4th, 
and again on the 5th ; and he took a 
mild purgative daily. 

June loth. — Pressure over the belly 
caused pain, therefore a blister was ap- 
plied to the abdomen, and mild purga- 
tives were continued till 28th June, when 
he was pronounced well. 



CHOLERA. 89 

The above case of gastro-enteritis, is 
inserted to shew how that disease, in 
some respects, approaches the febrile 
form of Cholera ; but wants the rapid 
pulse, conjee stools, and sinking of vital 
power. 

Case VIII. — Henry Johnson, Mi. 40, 
a sailor of the ship CasaVy of middle size 
and light complexion, one month arrived 
from England : admitted into General 
Hospital at 7 a.m. 28th June 1830. Has 
had a purging for 48 hours and began to 
vomit at 2 o'clock this morning; the 
purging abated since 5 a.m. and he has 
suffered from cramps in his thighs for the 
last half-hour. Extremities now warm. 
Pulse 112 and free; tongue warm and 
dry. Has some chronic enlargement and 
induration of the liver, which can be dis- 
tinctly felt. 

V. S. ad 5 xxvii. 
R. Calomel. 9 i. statim sumend* 
01. Ricini. 3 i. at 9 o'clock. 



90 CHOLERA, 

Half past 10 a.m. — One cup of the 
blood taken at 7 a.m. is buffy, the other 
not ; he has had two stools since admis- 
sion ; they are like rice-water. He com- 
plains of dreadful pain at scrob. cordis, 
and is crying aloud for drink ; there is 
great anxiety. Pulse 132, fingers shri- 
velled, but the extremities are still 
warm ; he voids no urine. 

Ilepet. V, S. ad, 5 x» 
R. Calomel. 3 i. 

Extract. Colocynth. Comp. gr. v. — misce 

fiant pil. u. statim sumend. 
Allowed 2 oz. of Cream of Tartar drink, 

every hour. 

2 P.M. — Blood not buffy, had only 
one return of cramps since half past 10 
o'clock. There is at present great anx- 
iety ; pulse 1 20 and soft : has had since 
last report, six copious watery conjee- 
like stools, in quantity at least 8 pints. 

R. Pil. Hydrarg. 3 i. 

Extract. Colocynth. Comp. 3 ss. 



CHOLERA. 91 

Opii gr. i. misce et divide in pil. iv. 
Two pills immediately^ and repeated in two 
hours. 

5 P.M. — ^By mistake tHe whole four 
pills were taken at once. He has vomit- 
ed once since 2 o.'clock, and had one 
pale-grey watery stool, with some floc- 
culi of mucus floating in it. Belly soft 
and elastic. Pressure over the abdomen 
gives some pain. Surface generally 
warm ; tongue warm and dry ; pulse 116; 
he is anxious and moaning. 

Apply 12 leeches to the beUy. 
Be. Calomel. 3 ss. • 

Extract. Coloc3mth. Comp^ 

Hyoscyami. aa gr. iv. misce et di-- 

vide in pil. ii. statim sumend. 

7 P.M. — Has had one scanty, feculent, 
dark stool ; pulse free, and there is less 
anxiety. 

Repeat the last prescription^ at 8 o'clock, 

June 29th. — Had during the night, one 
watery stool, of pale grey colour; no 



92 CHOLERA. 

sleep. He is now tranquil, and suffers 
no pain; pulse 116 and soft; tongue 
dry, and of morbid brownish-red colour ; 
edge of liver distinctly to be felt ; pres- 
sure gives slight pain. 

Apply four leeches to the^ region of the 
liver, 
R. Extract Colocjmth. Comp. 9 ss. 

Pil. Hydrarg. gr. v. misce fiant, pil. iii. sta^ 

tim sumend. 
Ol. Ridni. ^ i. at noon. 
Tea and thin sago allowed* 

Vesper. — Had four free, feculent, fluid 
stools, nearly black; pulse 108; skin 
rather cool ; he is very thirsty ; has no 
pain except in the calf of the right leg. 

Extract. Colocynth. Comp. 

Pil. Hydrarg. aa gr. v. at bed-time. 

June 3WA. — Had one stool at night, 

which is not kept for inspection ; pulse 

84; tongue clean and moist at edges, 

" but loaded, brown, and dry in the centre ; 

skin cool ; belly soft and elastic ; edge 



CHOLERA. , 93 

of liver to be felt as before: urine 
copious. 

H. Extract Colocjmth. Comp. 9 ss. 
Pil. Hydrarg. gr. v. in pills at 6 a.m. 
Ol. Ricini. i i. at noon. 

After this he took a mild purgative 
daily. 

In a few days more, there was in- 
creased tenderness in the region of the 
liver ; for which reason he was bled to 
lb. i. and leeches were applied four 
times: and by these means he recovered. 
I was informed that this man had several 
feverish attacks during the Voyage to 
India ; but since his arrival in Calcutta 
he had been in good health, and lived on 
shore at the Captain's house ; he was a 
sober man, of good character. 

Discharged 10th July, 1830. 

Case IX.— Thomas Cavender, Mt 30, 



94 CHOLERA. 

a sailor of the ship Roxboro' Castle; a 
stout and tall man, of dark complexion, 
recently arrived from England ; admitted 
26th October, 1830, at 8 a.m. Stated 
that he had been purged for three days ; 
and worked hard in the ship's hold until 
yesterday. He began to vomit at 10 
o'clock last night, and soon after had 
severe cramps in his legs and belly : the 
vomiting, purging, and cramps continue, 
and he has been purged often in the pa- 
lankeen, while being brought to hospi- 
tal. Pulse free and rather full, and he 
is warm ; eyes blood-shot. 

V. S. ad lb. i. 
R. Calomel. 9 i. 

10 A.M. — Blood not bufiy, he is cooler 
and weaker; cramps moderated; the 
stools consist of water, of a dark-brown 
colour, with little feculence; pulse 96, 
and weak. 

R. Calomel, gr. xii. 

Extract. Colocynth. Comp. gr. vi\ 



CHOLERA. 95 

Ol. Menth. Pip. gtt. ii. to be taken in two 
pills now^ and repeated in three hours. 

4 P.M. — Has been purged four times ; 
cramps returned, and he has pain in the 
, loins; but is better in having the warmth 
restored, and less congestion of the eye- 
balls ; pulse risen, and rather full. The 
vein was again opened and eight ounces 
of blood flowed. 

He was very faint, and vomited after 
the bleeding ; blood not huffy, it coagu- 
lated, but no serum separated. 

R. Extract. Colocynth. Comp. 

Pil. Hydrarg. aa gr. v. — ^to be taken directly 
— and in half an hour let him have 3 oz. Port Wine 
with sago. 

10 P.M. — The cramps continued till 
half past nine ; he is warm and tranquil, 
but very thirsty ; has had two dark-grey 
stools, moderate in quantity. 

Oct. 27th. — ^He passed a restless night, 



96 CHOLERA. 

without spasms or vomiting ; had much 
nausea, voided some urine ; and had two 
fluid black stools, in quantity about a 
pint : pulse 86 and moderate ; belly hot, 
full, elastic, and pained on pressure; 
tongue moist, cool, white, and very little 
loaded with mucus. 

V. S. ad lb. i. 
R. Extract. Colocynth. Comp. 

Pil. Hydrarg. aa gr. v. in pills at 6 a m. — 
and repeat at 10 o'clock. 

Noon. — Blood bufiy; he had one 
scanty loose dark-coloured stool, and 
seems better. 

Repeat the pills now ; and again at 3 p. m* 

Vesper. — ^Had three free stools, and is 
better. 

Oct 28fA. — ^Had no sleep, but says he 
feels well; the tongue is warm, moist, 
and loaded with white mucus. One dark 
feculent stool, in moderate quantity. 



CHOLERA. 97 

fk^ Extract. Colocynib. Comp. 3 gs. 
Calomel, gr. v. in pills at 7 '^•^« 
01. Hidni. 3 ss. in Aquae Cinnamon. ^ !• At 
noon* 

Fe^er. — ^Had three dark, fluid, fecu- 
lent stools ; vomited the oil ; suffers 
£rom pain at stomach and anxiety. 

Apply four leeches to £pigastre. 
A. Calomel, gr. xik h. s. 

He was better on the 29th, but com- 
plained of some pain in head and chest, 
unattended with pyrexia ; he took mild 
purgatives and had an enema which ope- 
rated slightly: he passed a bad night. 
On the JjOth October, he was feverish 
and had head-achie, for which reason six 
leeches were applied to the temples and 
four to epigastre : the head was shaved ; 
and he was ordered to take 

Extract. Colocynth. Comp. 9 ss. 
Pil. Hydrarg. gr. v. in the morning. 
01. Ricini. '% i. at noon — and 
Extract. Colocynth. Comp. — Pil. Hydrarg. 
aa gr. y. at night. 

F 



98 CHOLERA^ 

9 P.M. — ^These medicines have pro- 
duced two dark fluid stools ; he is anx- 
ious, and bool ; pulse low. Ordered to 
take 

Pil. Hydrarg. gr. vi. — Opii gr. i. 

He slept at night ; had two fluid stools 
of natural colour ; was cheerful and feel- 
ing well on the morning of 3 1st. In the 
evening there was some slight feverish- 
jness ; and he took 

Extract. Colocynth. Comp. 

Pil. Hydrarg. a,a. gr. v. 

Opii gr. i. in pills at bed-time. 

» 

On the 1st November, he felt better 
and had slept, but had no stool ; castor- 
oil or other purgative was given daily ; 
his diet was gradually increased, and he 
was discharged well on the 14th Novem- 
ber, 1830. 

Case X.— James Cawson, iEt. 23, a 
small man of light complexion, recently 



CHOLERA. 99 

arrived in Bengal ; ill 1 2 hours before 
I first saw him, on his arrival at the 
Hospital, on the evening of 7th June^ 
1827. He was then suffering with vio- 
lent vomiting and purging, the stools a 
clear water, not coloured in the slightest 
degree; he had no cramps; face flushed ; 
pulse 92 and regular. 

V. S. ad lb. j. 
R. Calomel. 3 i. in pills. 
R. Opiigr.ii. 

Spirit. AmmonisB Aromt. 3 i. 

Aq. Menth. pip. 3 i. misce — ^to be drank 
after the pills. 

June 8th. — Blood slightly huffy : he 
had four stools during the night, which 
are watery and of a pale-grey colour ; he 
is better; tongue clammy; pulse fuller; 
he feels weaker, and has inclination to 
vomit. 

Apply 8 leeches to scrob. cordis. 
R. Calomel. 3 i. 

Opii gr. ii. — misce fiant pil. ii. statim su- 

mend. 
Ol. Ricini. 3 ii. to be taken at noon. . 

F 2 



100 CHOLERA. 

June 9th. — He had three stools in 
the course of yesterday ; and three this 
morning. 

R. ' Calomel. 

Extract. Colocynth. Comp^ aaD ss. in three 
pills at 6 A. M. 

Vesper. — Had two very free stools, 
and is improving. 

R. Calomel. 3 ss. 

Extract Colocynth. Comp. gr. v. 

Opii gr. I^^to be taken in pills at bed-tune. 

June lOth. — Had four brown watery 
stools in tlie night, says he is well, but 
his face is flushed ; pulse 60 and soft. 

R. Calomel. 

Extract. Colocynth. Comp. aa gr. v. at 6 Aoc. 
R. OL Ridni. 3 i* at noon. 

He took a mild aperient daily, and 
was gradually improving till the 21st : 
when he appeared feverish, had a white 
tongue and flushed face. Pulse 88 and 
fuUL 



CHOLERA.' 10 L 

V.S.adlb-j. 
R, Extract. Colocynth. Comp. 
Pil. Hydrarg. aa gr. v. at 6 a.m. 
Pulv. Jalap. Comp. 3 i. at noon. 

This purged him freely; he took a 
purgative on the 23d, and was discharged 
well on the 28th. 

Case XI.— Pat. Whelahan, Mi. 27, 
H. M. 44th Foot, recently landed in 
Bengal. Was seized with purging early 
in the morning of the 22d May, 1827; 
but not sent to Hospital till 10 p.m. He 
then had cramps in the limbs ; the purg- 
ing and vomiting continued, and he had 
some pyrexia. Pulse 92 and free ; face 
flushed ; tongue little coated with white 
mucus. 

V. S. ad lb. j. 
R. Calomel 9 i. 

Extract Colocynth. Comp. 3 ss.-^misce fiant , 
pil. iij. statim sumend. 

May 23^.— Blood not bufly, he had 
three copious feculent loose stopls; is 



102 CHOLERA. 

very weak and faint ; tongue brownish 
and moist; cramps are still severe; pulse 
98 and regular. 

R. Calomel. 

Extract. Colocynth. Comp. aa 9 ss. 

Opii gr. i. — ^misce fiant pil. iij. statim su- 

mend. 
01. Ricinit 3 i* meridie. 

Vesper. — Had four scanty dark-brown 
stools, and vomited once during the day ; 
he is warm and tranquil ; has some pain 
at the navel. 

V.S.adlb.j. 
Blister to the belly. 
R. Extract. Colocynth. Comp.<-^Pil. Hydrarg. 
aa gr.v. 

May 24th. — Had four stools in the 
nighty and he is better ; still has some 
pain in the belly. Pulse 86 and soft ; 
blood not huffy. 

R. Extract. Colocynth. Comp. gr. v. 

May 25th, — Pain in the belly remains. 



CHOLEHA. 103 

with slight pyrexia and flushed face ; 
pulse frequent ; tongue hot. 

V. S. ad IK j. 
R. Extract Colocynth. Comp. 

Pil. Hydrarg. aa gr. v. at 6 a.m. 
R. Ol. Ricini. 3 i- ^t noon. 

May 26f A. — The blood last drawn was 
l)uffy, and separated a moderate quantity 
of serum. He was freely purged, and is 
much better in every respect After this 
date, a small dose of rhubarb was given 
every morning, and he gradually im- 
proved. Was discharged on the. 4th 
June, 1827. 

In -the month of May 1827, the num- 
ber of cases of Cholera received into the 
General Hospital was 149; of whom 
the greater number were attacked with 
the disease within ten days of this man's 
admission. 

CaseXH.— Wm. Morris, iEt. 21, a 
middle-sized man, of light complexion, 



104 CHOL£RA. 

recently arrived in India, was seized 
with vomiting, purging, and cramps in 
his legs, at noon, on the 22d August 
1830, which symptoms continued when 
he was seen at 2 p.m. ; his pulse was 
then 102 and rather small; he was per- 
spiring profusely, and the skin was cold, 
but his tongue was warm, clammy, and 
nearly clean ; he experienced great thirst 
and anxiety, and felt very weak. 

V.S.adlb.j. 

Capt. Calomel* 9 i. in Pil. ij. statim.. 

6 P.M. — He was faint, when only 3 xii. 
of blood flowed, which was not bufly 
when it had cooled : vomiting and purg- 
ing have ceased ; he has had no cramps 
for the last 20 minutes ; anxiety re- 
mains, but his skin is warm, and he 
perspires Ipss. Belly hot, inelastic and 
doughy. 

R. Calomel. 

Extract. Colocynth. Comp« aa 9 ss. — misce 

fiant pil. iij. statim sumend. 
Enesia Purg. statim. 



cholera; 105 

8 P.M. — ^The Enema has produced no 
stool. Cramps in his legs have returned ; 
there is increase of heat on the surface, 
and slight perspiration on the face. 

The vein was again opened ; and when 
14 oz. of blood had flowed, he became 
faint, and the perspiration increased. 

Ik. Ol. Ricini. i iss. 

11 P.M. — He is very weak; pulse 116 
and hardly to be felt ; the surface is cool, 
and he is suflering from great anxiety ; 
tongue warm. He has had one copious 
stool, of pale yellow colour. 

To have Port Wine i iij. with as much hot 
sago. 
R.. Calomel. 9 i. 

Opii gr. i. — ^misce fiant pil. ij. statim. 

August 23d. — Had cramps nearly all 
night, pulse 108 and weak, tongue clean 
and rather dry : he vomited once since 
11 o'clock, and had a scanty fluid brown 
stool, not 3 oz. in quantity. 

f3 



106 CHOLERA. 

Tk, Extract. Colocynth. Cpmp. 

Calomel, aa 9 sa^-^-misce '£ant pil. iij.— to b^ 
taken at 6 a. m« — and Castor Oil J i. at 10 o'clock. 

3 P.M. — Had two free fluid stools ; the 
belly is hot, and he has some jmin below 
the navel. A small cup of sago allowed. 

Apply' four leeches to the belly. 
R. Extract. Colocynth, Comp ... 

Pil. Hydrarg. aa gr. v. — ^misce fiant pil. ii. 
statim'sumend. 

9 p.m. — Pulse 103; he is free from 
pain, but feels very weak : has had ano- 
ther copious fluid stool, nearly black. 
Give Ih oz. of Port Wine, with 3 oz. of 
thin and hot sago. 

August 24th. — He slept, and is much • 
better; had one stool of the same ap- 
pearance as the last. Diet — tea, bread, 
and sago. 

R- Pil. Hydrarg. gr. v. 

Extract. Colocynth. Comp. 9ss.«-raisce fiant 
pil. ii. statim sumend. 



CHOLERA. 1 07 

' The above medicine produced free 
stools, and he was convalescent next day. 
A mild purgative was given daily till the 
3d September, with the exception ot 
only two days. His recovery was pro- 
gressive until the 27th August : he then 
for the first time ate some meat^ and was 
feverish next day : therefore a reduced 
diet was enjoined for several days longer. 

The bad effects of premature use of 
animal food, were very evident in this 
instance. In all cases of Cholera, where 
febrile or inflammatory symptoms have 
existed, the same caution is requisite as 
to the food used during convalescence as 
in ordinary cases where patients are re- 
covering from gastro-enteritis. 

Case XIII.— George Mogg, Mt. 20, 
a middle-sized lad, of light complexion ; 
recently arrived in Bengal : received into 
the General Hospital at 7 p. m. June 7th, 
1827. Has been affected during the 



108 CHOLERA. 

whole day with ptirgiiig and severe 
cramps in the legs. , Pulse feeble and 
frequent ; skin cold ; he is suffering 
much from pain all over the belly, and 
has head-ache, 

V. S. ad 3 XX. — He was ordered to take im- 
mediately. . 

Calomel 3 i. in pills : and at the same time 
the following draught : 
R. Opii gr. ij. . 

Spirit. Ammonise Aromat. 3 i. 

Aquae Menth. Pip. J ii. misce. 

June 8th. — Blood bufly, very little se- 
rum separated. He had several feculent 
stools in night, of light-grey colour, and 
feels better ; but still has head-ache, and 
there is pain in the belly, increased on 
pressure ; no morbid heat of skin. Pulse 
frequent but more free, tongue clammy. 

Apply 16 leeches to the belly. . 
R. Calomel. 3 i. 

Opii gr. i. fiant pil. ii. statim sumends^. 
Capt. Olei Ricini J ii. meridie. 

Vesper. —tie has. had numerous free 



CHOLERA. 109 

feculent stools, and feels better : tongue 
white. 

R. Calomel. 

Extract. Colocynth. Comp. aa 3 ss. 
Opii gr. i. fiant pil. iij.^H. s^ sumend^ 

June 9th. — Had one scanty niucous 
stool, at night. Pain in the belly con- 
tinues : tongue white. 

Capt. 01. Ricini J i. 

Apply 16 leeches to the belly^ 

He took Castor Oil daily on the 10th 
and 11th June; on the 13th, was consi- 
dered convalescent, and meat diet al- 
lowed. 

On the 1 9th June, he was attacked 
with fever, and head-ache : and the bow- 
els were not sufficiently free ; pulse fre^ 
quent but not very full. Diet reduced 
to tea and bread. 

V. S- ad lb. j. 

Apply ten leeches to the temples 
R. Pulv. Jalap. Comp, 3 u 



110 CHOLERA. 

' Vesper. — ^Blood buffy; head easier, 
but he is still feverish and thirsty; he 
was purged five times in the course of 
the day. 

R. 'Calomel, gr.v. 

Extract Colocynth. Comp. gr. xii. 
Pulv. Antimon. gr. iij, — misce fiant pil. iij. 
H. 8. sumend. 

June 20th. — Vomited twice, and had 
eight stools at night ; he is now sufiering 
from pains in his legs and thighs ; py- 
rexia somewhat abated. 

V.S.adlb.j- 
R. Extract. Colocynth. Comp. 9 ss. 

Calomel, gr. y. in pil. ii. statim. 

June 2 1 St. — Blood bufiy ; he was freely 
purged ; no pyrexia remains. . After this, 
he was purged with Castor Oil, and on 
the 28th June, discharged to join his 
Regiment. The evil consequences pro- 
duced by a premature use of animal food, 
were evident in the febrile and inflam- 
matory condition, which took place on 



CHOLERA. 1 1 1 

the 1 9th June ; requiring active deple- 
tion and a return to low diet. 

• I . . . - 

Case XIV. — Joseph Bowdem, Mi. 19, 
a sailor of the French Ship Victorine^ 
admitted into General Hospital 25th 
October, 1830, at half past 6 a.m. A 
slight-made lad, of light complexion; 
sailed from France twenty-two months 
ago, and has been to Peru, from whence 
lie arrived in the river Hooghly fifteen 
days ago ; and has been working hard 
in landing the ship's cargo, which .is of 
dopper. * He had -a diarrhcea for a fort- 
night, which ceased for two days, and 
returned last night, witli the addition of 
cramps in his limbs and vomiting. He 
is now in the act of vomiting the crude 
remains of food. Skin covered with a 
cold sweat ; pulse 120 and weak ; tongue 
warm, moist, and nearly clean ; he is 
very pale, and has some oppression at 
chest. The cramps are at present severe 
in his feet and legs. 



Il2 CHOLERA. 

V-S.adlb.i. 
R. Calomel. 9 i« 

Opii gr. ii, — ^misce fiant pil. ii. statim su« 
mend. 

8 A . M.-^^He was weak and faint when 
only 12 ounces of blood had flowed ; it 
is black and not bufify, but a coagulum 
has formed, and the serum is bloody. 
Has had two brown, watery stools, about 
lb. iss. in quantity ; has not yoixiited ; 
be suffers from great anxiety and desire 
for drink. Pulse weaker. 

R. Extract. Coloc3nith. Comp. 9 88. 

Pil. Hydrarg; gr. y. misce fiant pil. iii.«»to 
be given at 9 o'clock.. 

2 P. M. — ^Has had one scanty stool, 
like barley water ; vomited very often ; 
cramps have ceased. He is cold and 
feeble; tongue white, cold, and moist; 
pulse 122, and very weak. He is thirsty, 
and appears stupid.. 

R. Calomel. 9 i.— Pulv. Jalap. Comp. 3 i. 
Pulv. Scammon. Comp. (Ph. Ed.) 3 ss. to be 
given now^ mixed in treacle^ 



CHOLERA. 113 

6 P. M. — ^Had one scanty watery stool, 
almost white; vomited several times, 
and suffers from cramps in his legs and 
fingers. 

Half past twelve at night ; he has had 
one pale-grey fluid stool, and vomited 
twice since 6 p.m. Pulse low, weak, 
and rapid ; voice pectoral. He is torpid 
at times, and then lies in a restless state 
for a few minutes : fingers shrivelled, but 
there is not much perspiration except on 
the face ; extremities cold and damp ; 
he is certainly worse. Ordered to 
take three ounces of Port Wine with 
sago. 

October 26th. — Slept after the sago 
and wine ; he is now cheerful and warm ; 
the tongue is warm, moist, and white ; 
pulse stronger: he has had two stools, 
chiefly of a dark-grey colour, but a part 
of the evacuations nearly black. Di^t— • 
tea, and sago with wine^ 



114 CHOLERA. 

R. Extract. Colocynth. Comp. 

Pil. Hydrarg. aa gr. v. in two pills^ to be 
taken at 7 a. m. and repeated at 10 o'clock. 

4 p. M. — Free from cramps ; the skin 
cold, pulse low and weak ; he has had 
two scanty, black, paste-like stools. Re- 
peat two pills such as ordered this 
morning. 

Half past 9 P m. — Pulse feeble and 
frequent, hands cold, tongue white, cool, 
and moist: since 4 o'clock he has had 
two free fluid stools, like gruel in con- 
sistence, but black. 

R. Calomel. 9 ss. . . 

Extract Hyoscyami. gr« vi. in pills h. s. 

Oct. 27th. — ^Had one scanty stool, like 
that last reported, but has not vomited, 
or had any cramps : hands cold, pulse 
1 1 0, and he craves anxiously for drink. 

R. 01. Ricini J i* statim sumend. 
•R. Pil. Hydrarg. 



CHOLERA. 115 

Extract. Colocynth.Comp.aagr.v. inpills^ 

at noon^ and repeat at 3 p. m. 
Diet of tea^ breads and sago, with 3 oz. of 

Port -wine. 

8 P. M.— Had two dark fhiid stools, 
moderate in quantity, and thinks he is 
better. 

R. Calomel. 3 ss. H. 8. 

Madeira Wine^ three ounce»^ with Sago. 

Oct. 28th. — Slept ; had two scanty 
black stools during the night : one more 
free evacuation this morning, of yellow 
colour. He is better ; the hands warm, 
pulse feeble, and mouth slightly sore from 
mercury. 

Ordered to take CalomeL gr. v. at 7 A. m. 
01. Ridni*— Aquie Cinnamon, aaj i. at noon. 

F(f^j9er.— Pulse improved; face livid, 
and eyes very dull ; he has had two free 
loose stools, is warm, and feels better. 

R. Extract. Colocynth. Comp. 
PH. Hydrarg, aagr. V. 



116 CHOLERA. 

At 9 P. M.— He was anxious, low, and 
colder. 

R. Pil. Hydrarg. gr. vi. 

Opii gr. ss« miace fiant pil. h. s. sumend. 

Oct. 29th. — ^He slept, and is better; 
had one stool : mouth sore ; tongue 
moist, and coated in centre with white 
mucus. After this; a slight feverish 
condition remained for several days, and 
he took some purgative daily. On the 
2d November, he was troubled with an 
eruption on the skin, resembling urti- 
caria. Mild purgatives were continued, 
and his food very gradually increased. 

Discharged well on the 10th No 
vember. 

Case XV.— Peter Mathews, Mt. 23, 
of middle size, and dark complexion ; 
recently landed from Europe : was taken 
ill on the morning of 19th Noveniber, 
1830, with purging and vomiting ; which 



CHOLERA.. 117 

continued when he was admitted into 
General Hospital, at 5 P. M. He was 
then warm and had a soft free pulse, no 
cramps. 

V. S. ad lb. iss. 
R. Calomdl. 3 i. — Opii gr. ss. statim sumend. 
R. Calomel. 3 i. — Extract. Colocynth. Comp, 
9ss. 

Opii gr. ss. to be taken in pills at 10 v. M. 

Nov. 20fA.— Blood not buffy, and the 
surface of the cruor is florid ; he .vomited 
three times, and was purged often during 
the night; the stools are tinged with 
bile. Pulse 112, and very weak; he 
suffers from great anxiety and thirst; 
tongue cool, white, and dry ; skin nearly 
cold. 

R. Calomel. 3 i. — Opii gr. i. in pills at 6 A. M« 
Diet— Tea^ and hot Sago with some Brandy* 

2. P. M. — No stool or vomiting since 
the morning. Pulse low and weak ; he 
is cold, and sinking. 



118 CHOLERA. 

R. CalomeL 3 i. 

Extract. Colocynth. Comp. — Asafoetid^e aa 

gr. V. 
01. Cinnamon, gtt. ii. to be taken in two pills 

now. Sago and Brandy repeated. 

5. P. M. — Had five stools, partly watery 
and "black, partly feculent. . Repeat the 
pills at 5 and again at 8 o'clock. 

10 p. M. — Had ten free, dark, and fe- 
culent stools ; perspires, and is very faint. 

R. Pil." Hydrarg. gr. vi. — Opii gr. i. in a pill 
now. 

Nov. 2 Uf.— Slept after 3 a. m. and is 
better ; had no stool. Pulse 98 and soft. 
Diet — ^tea, bread, and sago. 

R. Extract. Colocynth. Comp 

Pil. Hydrarg. aa gr. v. at 6 a. m 
01. Ricini 3 i* at noon* 

Vesper. — ^Had four free, fluid, dark 
stools, after the oil; feels very weak; 
tongue cold, but the extremities are 
warm ; pulse free and natural. 



CHOLERA. 119^ 

R. Pil. Hydrarg. gr. vi. — Opii gr. i. 

Nov. 22rf. — Had more dark-grey fluid 
stools in night, moderate in quantity r 
the surface of his body is warm and pulse 
free ; tongue continues cool, moist, and 
much loaded with grey mucus. 

R. Extract. Colocynth. Ck)mp.-^Pil, Hydrarg. 
aa gr. v. 

After this, he took a purgative daily. 
Was feverish, and had a pain in chest on 
the 26th, for which he was bled, and a 
purgative of Jalap used. Discharged 
well on the 29th November. 

Case XVI.— Daniel Watson, 2EX. 25, 
a sailor of the ship Bridgewater^ admitted 
2d June, 1830, at 6 p.m. A tall thin 
man, of light complexion, ill two days 
with vomiting and purging. He is now 
in the beginning of collapse; pulse 
feeble, 96, and soft; he is covered with 
a profuse perspiration; vomits water, 
which he has just drank. Purging, a 



1^ CHOLEllA. 

grey watery fluid. Eyes blood-shot ; belly 
ftJl, doughy, and inelastic ; tongue clean, 
moist, and of morbid red coloilr. Has 
cramps at the pit of stomach now, and 
had cramps in the soles of his feet 
three hours ago. 

R. Calomel* 9. i. 

Extract. Colocynth. CQmp.^.vi. 
01. Menthse. Pip. gtt. ii. in two pills. 

Ju7ie 3fif.— -Vomited twice ; and ' was 
purged five times; the circulation is- 
more free ; face flushed ; the tongue of 
morbid red colour at edges, a little white 
in the centre, and rather dry ; stools a 
conjee-like fluid, with some pale-grey 
powder at the bottom of the pan. 

V.S.lb.i. 
Be. Calomel. 9 i. — Extract. Colocyuthv Comp^ 
gr.vi, 
01. Menth. Pip. gtt. ii. in pills at 6 a.m. 
01. Ridni 3 i« at noon^ 

re^j^er.-— Has had four dark fluid 
stools, and he is better. Blood slightly 



CHOLERA. 121 

buffy, it has separated a very small quan- 
tity of serum. 

R. Extract. Colocynth, Comp. — Pil« Hydrarg. 
aa gr. v. misce iiant pil. ij. statim sumendae. 

June 4th. — ^He has had four copious, 
dark stools during the night; and has 
now some pain in the region of the 
liver. 

Apply eight leeches to the region of the 
liver. ^ 
R. Extract. Colocynth. Comp. 9 ss.. — Pil. Hy- 
drarg. gr. V. 

June 5th. — Has had seven stools, and 
is better. 

R. Extract. Colocynth. Comp. 9 ss. 
Pil. Hydrarg. gr. v. at 6 a.m. 
Pl. Ridni J i. at noon. 

After this a course of mild purgatives 
was followed, and he soon recovered 
good health. 

G 



122 GHOLfiRA 

Case XVII;.-^eor^e Pat^ ;Mi. 
H. M. 16th Lancers, admitt^ kit<6 Ge^ 
neral Hospital on the 18th November 
1 830, in" the eveniiig. A tall thin man, 
of light complexion, recently landed 
from Europe : ill one day, with purging 
and slight fever ; has voided no blood. 

V. S. ad lb. iss. 
R. Ext. Coloc3mth. C— Pil. Hydrarg. aa 9 ss. 
statim. 

Nov. 19th. — Blood florid itod not 
buffy ; he fainted when 8 o^. of blood 
had flowed; had six stools in night, 
which have not been kept; he is now 
cool and weak ; pulse softer and natu- 
ral ; belly flat and hard, the abdominal 
muscles tense. 

R. Calomel. 3 ss. 

Extract. Colocynth. Comp. gr. V. statim su- 

mend. 
Apply six leeches to the ispigastrium* 

1 P.M. — One copious stool, like bar- 



OHOLBRA, 123 

ley^water; eyes blood-^hot, «kin hot; 
has not vomited. Pulse 92 and free; 
face flushed; tongue white, moist, and 
warm. 

V.SLlb.i. 
R. Calomel. 3 8s.-*£xtract. C«loeyiith. Coxnp. 
gr. V. now. 

Fe^joer.— -Fainted after the V. S. The 
blood is not huffy; he has had two 
stools. Th'e tongue is cold^ moist, and 
white ; pulse weak : he suffers from 
anxiety, is pale and low ; and has the 
Cholera visage. 

R. Calomel. 3 i. — Extract. Colocynth. 3 ss. 
Opii gr. J, now^ and repeat at 10 o'clock. 

Nov. 20/A.— Two stools during the 
night, and he feels better ; the evacua- 
tions are watery and of dark colour; 
the right eye is still blood-shot, and 
there is slight moi*bid heat of skin. 

R. Extract. Colocynth. Comp. 9 ss. 

Pil. Hydrarg. gr. v. at 7 a.m. and repeat at 
noon. 

g2 



124 CHOLERA. 

6 P.M.— He has had two stools, con* 
sisting of a dark fluid feculence ; and is 
better. 

R. Extract. Colocynth. Comp. 

Pil. Hydrarg. aa gr. v. now^ and repeat at 
10 o'clock. 

Nov. 21^^— He is improving, and has 
.had several scanty, fluid, dark stools; 
surface of body warm ; but the tongue 
is cool. 

R. Extract. Colocynth. Comp. 9 ss. 
Pil. Hydrarg. gr. v. at 7 a.m. 
Ol. Ricini ^ i. at noon. 

T^^er.— Much better; three free stools. 

Nov. 22^.— One stool in the night, a 
whitish mucus, not in large quantity ; he 
is warm and seems better ; more arterial 
congestion of right eye. Pulse soft and 
free. 

R Ex tract. Colocynth. Comp. 

Pil. Hydrarg. aa gr. v. at 7 a.m. 



CHOLERA. 125 

Vesper. "-^Better ; two stools. 

Pil. Rhei. Comp. gr, vi. 

NoVi 23rf.— Has had one free, fluid, 
dark stool ; he is rather better. 

Pil. Rhei. Comp. gr. xii. at 7 a.m. 
, Ol. Ridni J as. at noon. 

Pil. Aloes Comp. gr. v. to be taken at bed" 
time. 

Nov. 24M.— Better. 

Ol. Ricini 3 i. 

Vesper, '^One stool; he is gradually 
recovering. After this he took a pur- 
gative daily and was discharged well on 
the 29th November. 

The morbid vascularity of one eye, in 
this case, was very remarkable ; the left 
eye was slightly red on the 19th, while 
the right was injected with florid red 



126 CHQtLEBl&. 

blood, to a most intoose. degree; and 
continued in that state, long, after the 
redness of the left had entirely subsided. 
I have seen children suffering from Cho- 
lerai with very obscure inflammatory 
symptoms, in whom the cornea of one 
eye became dull, and an ulcerated grove 
formed at the lower segment of the cor- 
nea; by which the humours were eva- 
cuated before death* 

Case XVIII. — John Dempsey, JEt. 
20, a very muscular lad, of dark com- 
plexion, recently arrived in Bengal, was 
attacked with vomiting and purging at 
10 A.M. on the 26tk March, 1826; for 
which he was. bled from the arm^ astd 
took two saoaiL pilU; but does not know 
their composition. Hia. cxunplainta con- 
tinuing to get worse, and, being attended 
witin other bad symptoms of Ghokca, he 
was^ sent ta Grcsieral Hospital,, where hie 
arrived at 7 a.M; on the 2i?th March:; 
his countenance was» theor sank aaad 



ghasUy (the trw ChoJwa visage). Pulse 
80, and weak ; he sufi^ed from extreme 
thirst, and haii paina in his legs ; some 
pain on pressing over the belly: skin 
cool and lax; tongue cool, clammy, 
moist, and brownish. 

V, S. ad 3 XX, 
Be. Calomel,. B L 

Extract* Coiocynth. Camp. 3 ss. misce fiant 
pil« iii. — to be taken now^^ and repeated in 1^ hour. 

As the patient appeared last approach- 
ing a state of torpor from obstructed cir- 
culation, and the blood only- came from 
the orifice in the vein by drops; 20 
leeches were applied to the belly, and 
they filled very slowly : at the same time 
by pressing and rubbing the arm, the 
blood continued to drop from the vein 
for nearly^ two hours; and 20 ounces 
were collected in the cup. 

At 10 A.M.— fHe is suffering from great 
anxiety and thirst ; has a broWn dry 



128 CHOLERA. 

tongue ; the extremities are cold ; pulse 
110 and feeble; he has not vomited or 
been purged since admission. 

R. Ol. Ridni 3 iss- 

Aquae Cinnamon. 3 iv. — misce ; to be taken, 
now^ and repeated at 1 p.m. 

4 P.M — ^Pulse more distinct, but still 
low and feeble ; the feet are cold, tongue 
brown and dry : he has very little unea- 
siness on pressing over the belly; has 
neither vomited, nor been purged since 
he came to hospital. 

Apply 30 leeches to the belly, and a large 
hot poultice after thdr removal. 
R. Ol. Croton, gtt. iv. 

Ol. Ricini. — Ol. Terebinth. 

Magnesiae Sulphatis aa 3 i« 

Decoct. Oryzae. lb. i, misce; fiant enema» 

6 P.M. — ^Much in the same state as last 
reported; has had two, copious, fluid, 
grey stools. 



CHOLERA. 129 

Capiat 01* Ridni J iss. statim. 
Directed to drink 3 oz. of thin and hot sago 
afterwards. 

Apply sinapisms to the feet 

March 28M.— -Appears better, the 
anxiety and restlessness have ceased, the 
eyes are less sunk, and he has no pain if 
the belly be pressed ; the extremities are 
warm, and pulse somewhat revived, but 
still low and soft. The tongue continues 
brown and dry, and he suflFers from ex- 
treme thirst. Has had two copious, 
grey, feculent, fluid stools. 

R. Ol. Ricini ^ iss. 

Aquae Cinnamon. J ss. — misce ; to be taken 
at 6 A.M. and repeated at 11. 

An Enema, such as ordered at 4 p.Af . yester- 
day^ is to be given at 6 a.m. and repeated at 11. 

Fe^er.— He had two, copious, loose, 
grey stools; skin warm, tongue moist 
and brown: pulse 110 and soft. The 
Cholera visage is no longer present. 

g3 



130 CHQL£R&. 

Repeat dnrCastor.Qii J is8*;.alaQ Ad Enenm 
as at II* 

March 29<A.r^He is. easy ajad cheer- 
ful : pulse 98 and soft ; tongue cleaner, 
but still rather dry, and little coated with 
grey mucus ; had three copious stools of 
bright bilious yellow colour, 

Ol. Ricini 3 i. at 6 A.M. 

Enema as before^ ta.be given at noon* 

T^id Batb. 

He remained feverish for several days; 
and required purgatives to be repeated 
daily, until the tongue became clean. 
He recovered, and was discharged from 
hospital on 17th April. Although this 
man was apparently so much oppressed 
and low; the pain on pressure over 
the belly, on admission; and the dry 
brown tongue afterwards: shewed the 
existence of an inflammatory condition, 
for which depletion was the only proper 
treatment. 



OtfOL^RA. 131 

The next case affords an example of 
the diffieult and unmanagetable state of 
disease, which exists in those cases where 
Cholera is preceded by a diarirhoea of 
several days duration* This patient 
shewed some signs of re-actioni after 
being a few hoiirs in Hospital; and his 
actual condition tben> if abstractedly 
considered, might have been deemed 
much more favourable than Dempsey's 
case : but it verified the observation I 
have often before had occasion to make, 
regarding thp dangeroua nature of those 
cases, which patients denominate a com- 
mon bilious attack ; more especially if it 
occur at a time when Cholera is frequent 
in the vicinity. 

Case XIX*— Pierre Francis Poussa- 
dore, Ml 37, a French sailor, arrived in 
the river fifteen days ago, from Peru ; and 
has worked very hard in unlading the 
ship, which brought a cargo of copper. 
Had diarrhcaa for five days past: he 



132 CHOLERA. 

was seized with vomiting and cramps iri 
his legs, at noon on the 24th October, 
and was brought to the General Hospi- 
tal at 10 P.M. ; he was then in the act of 
vomiting, his pulse feeble, surface cold, 
tongue cool, skin of his hands shrivelled, 
respiration hurried, and voice weak and 
pectoral : thirst extreme. 

R. Calomel. 3 i. 

Confect. Aromat. 3 i. To be mixed with a 
little treacle and given directly. To take in two 
hours after, 

01. Ricini — ^Aquae Cinnamon. §la J i. 

October 25M.— No sleep; and no 
stool during the night: he vomited about 
an hour after taking each dose of medi- 
cine, and at two other times in the 
night; has occasionally cramps in the 
fingers and toes. Pulse 92 and free; 
face little flushed ; skin warm ; tongue 
rather dry and brown. He suffers ex- 
ceedingly from anxiety and restlessness ; 
voice continues pectoral, and he is quite 



CHOLERA. 133 

frantic and unmanageable, calling con- 
stantly for drink. 

V. S. ad lb. i. 
R. Calomel. 9 i. 

Confect. Aromat* 5 i. to be taken at 7 a.m. 

OL Ridni i i. at 10 o'clock. 

To take Sago with 3 oz. of Port Wine at 

11 A.M. 

Extract. Colocynth. Comp. gr. xii. 

Pil. Hydrarg. gr. vi. in three pills at noon. 

At 2 P.M. — The cramps have ceased. 
Blood drawn in the morning not buflFy ; 
circulation lowered ; he had two scanty 
white stools like flour and water ; he is 
cool, and says he feels himself better, 

R. Calomel. 9 ss. 

Pulv. Jalap. Comp. 5 i. to be taken in 
treacle. 

At 6 P.M — ^Had no stool 7 thought 
himself rather better, but he was colder. 

At half past 12 at night, had one 
scanty stool, like that last reported ; no 



134 CIfi>LSRA« 

retani of cramp, but the puh» is very 
feeble, and voice pectoral ; skin neariy 
cold, and he appears anxious, low, and 
Weak. 

To take Sago a^ three ouncefl' of Port 

Wine. 

Oct. 26<Ak-t^lept for three ham*s, and 
says he fb^ls much better ; has fK> pain ; 
tongue little furred and brown, but warm 
and moist. 

Re. Extract Ckdocynthi Comp. 

Calomel. aagr«y« at 6 a«m. ood^repeat at 

10 o'c]o^, 
Ol. Ricini 5 i- at noon. 
To have 3 oz. of Port Wine in hot Sago, j 

At 4 P.M.— Had two, black, paste-like 
stools ; moderate in quantity ; tongue 
brown and moist : he appears better, but 
is still cold. 

R. Extract. Colocynth. Comp. 3 ss. 

PiU Hjdrarg. gr. v. in three pUla now- 



CBiXUSSiX. 136 

At half past 9 p;M<'-«Has hmd a very 
scanty black stool, in quantity not 3 ss. 
Pulse feeble and unsteady ; tongue moist, 
brown, clammy, aud cool ; voice pecto- 
ral ; hands shrivelled, and covered with 
a cold sweat. 

R. Calomeli 3 i. in pills. 

To take 3 oz. Port Wine in hot Sago. 

Oct. 27fA.— Had one scanty figured 
stool ; not 3 i. Pulse 110; he suffers 
from urgent thirst, and inclination to 
vomit ; surface cold. He has a trouble- 
some cough, and copious mucous expee- 
toration. 

R. Pulv. Jalap. Comp. 5 i. 
TiiiQt>.i8«i|iw© 3ji# 

Aquae Menth. Pip. J i. — ^miQoe^ to be taken 
at 7 A.M* 

Noon.— Vomited once, and had one 
scanty stool, like the last : he is cold, 
weak, and the extremities are perspiring; 
tongue cold, moist, and white. 



136 CHOLERA. 

Habeat £^ema Purg. statim* 
R. Ol. Ricini 3 i. 

Cum Tinct. Sennse 3 ii. 

3 P.M. — Nothing voided but the ene- 
ma : tongue cold, vexy brown in the 
centre, a narrow red clean streak at its 
edges. Increased anxiety ; he is eagerly 
calling for water, and at times delirious, 

Jk, Calomel. — Pulv. — Scammon. Comp. (Ph. 
£d.) aa 3 i. 
To be taken in treacle. 

8 P.M.— -Had one scanty black mucous 
stool; says. he is better, but appears 
weaker ; surface cold, and pulse hardly 
perceptible. 

R. Calomel. 9 ss. — Extract. Colocynth. Comp. 
gr.v. 
Opii. gr. -J- in pills. — 1^ oz. Brandy in hot 
Sago. . 

Oct. 28M, 5 A.M.— He has had one 
scanty stool, like tar ; pulse hardly per- 
ceptible;, he is quite cold, and slowly 



CHOLERA. 197 

sinking ; cough and expectoratipn very 
troublesome in the night. 

R. Calomel. 9 i. in Sugar. 
R. Pulv. Scammon. Comp. 5 ss. 
' Pulv. Jalap. Comp. 3 i. 
Tinct. Semiae 3 ii. 

Aquas Menthae J iss. misce^ to drink after 
the dalomel. 

At 8 A.M. — Indifferent and torpid ; no 
stool. Sago and wine was given ; also 
an injection of four pints hot water with 
the pump: which was repeated in an 
hour and brought away some flocculi of 
white mucus. 

Died — at half past 9 o'clock. 

Dissection^ at 4 p. M.-^Subj.ect emacia- 
ted. Stomach and small intestines con- 
tracted, the former pale, the latter of dull 
lurid colour ; a quantity of water in the 
stomach, much pale grey mucus and yel- 
low bile in the small intestines. Colon 
and rectum pale, thin, and flaccid : liver 



133 CHOLERA. 

slightly eHlafged^ soft^ and a few smaU 
pale-grey patches on its suifaco. Much 
venous conjestion of the lungs^ and thick 
mucus in the air tubes; QQot^er disease 
observed. 

This man belonged to the French Ship 
Victorine^ and the history of the Cholera 
on board that vessel was noost lamenta- 
bk : she was tweniy^two. mqelhs from 
France, having first made the voyage te^ 
Peru; and brought a cargo of eopper 
from thence to Calcutte, wh^re sher ar- 
rived in October. Her crew, consisting 
of Frenchmen, worked hard for fifteen 
days in landing the copper^ and during 
the greater part of that time many of the 
crew suffered from diarrhoea ; whiob was 
ascribed to drinking the Ganges wat^jr, 
when heated at work : they had all b^en 
on shore once or oftesaier. Several of 
the men without any evident cau8ier;b€)f 
came suddenly much more purged, before 
mid*day, on thejS4th Ootobwi mA gr^pr 



.^A 



CBOLKR^ 139 

dually sunk mto a low stat^, in w\mh 
they derived no benefit from any of the 
remedies tried on boaid. Nine men were 
therefore landed : ono Qi whom died 
while being oarried os shore* aod aiu;)^ 
tfaer was foimd insensdUe loiddiying whc^n 
he was taken out of the paladkeen at the 
Hospital. The. rest w^re admitted inan 
advanced stage of collapse, and four 
more of tbem died of the difieasie. The 
loaded state of the mueotts membraae of 
the bronchial tubes and air cells, was 
less distinctly marked, in the others who 
died than in this case^ Th^ appearan^^ 
of re^actioDL on the S^th iiiduoed me to 
me thue kficet, aixd although the force of 
the cir^iilation: waslowefed by the bleed- 
ing, I woidd willingly haye repeated the 
V. Sv in hopes* of giving more fr-eedoro to 
the circuladtion, but the man refui^d to 
submit to it The progress of the sii]d^Qg 
after the blood was^ drawn,, though not 
rapids was^regnkr ^ad undeyiatii^ The 
g^ieral character of the attains of Cho^- 



140 CHOL£RA. 

lera on board this man's ship, was most 
distinctly of the low kind, tending to fa- 
tal termination with little re-action : and 
we are never certain of benefit from 
bleeding in these cases ; on the contrary, 
we have evidence that in such forms of 
the disease, V. S. is very frequently 
injurious, and seems to shorten life. 

At pages 64 and 65, I have endea* 
voured to point out the general character 
of Cholera, attended with febrile and in- 
flammatory symptoms, such as existed in 
the cases that have been detailed ; in 
which, all the worst appearances are 
usually moderated by the use of the lan- 
cet ; and cured by a system of depletion, 
regulated according to the severity of 
the symptoms. In the foregoing cases, 
wherever the state of the blood which was 
drawn is merely reported not buffy, it is 
to be understood that there was about the 
usual quantity of serum separated, and 
that the surface of the cruor did not 



CHOLERA. 141 

materially differ from the ordinary ap- 
pearance of venous blood drawn from 
persons in health. 



Blood-letting frequently Injurious 
IN congestive Cholera. 

In almost all the foregoing cases. 
Blood-letting seems to have bqen deci- 
dedly useixd ; in some by removing con- 
gestion, and in many others by reducing 
pyrexia, and obviating early local inflam- 
mation : or by subduing the inflammation 
arising at remote periods. Still, to ad- 
vise the use of the lancet in all cases of 
Cholera, would often lead to disappoint- 
ment ; as happened in some of the suc- 
ceeding examples, in which the early 
collapse, and general character of disease 
alluded to at pages 67, 68, and 69 exist- 
ed ; and in which it is often difficult to 
procure blood from a vein. But in maiiy 
of the cases where blood will flow, the 



142 CHOLBRA. 

system is lowered, and all the important 
sjrmptoins aggravated. The fact is, that 
in this low form of the disease, which 
frequently prevails at the early stage of 
an Epidemic attack ; we can often get 
as much blood from a vein, as does harm ; 
and might almost always procure blood 
from the larger arteries ; if the principal 
desideratum Were simply to imdioiad the 
vascular sy^ctn. We are apt n^t to 
distinguish the low state, at^e onset of 
tile disease ; from the collapse whi^ su- 
perveneii on the latter stages of the febrile 
Cholera, when the patient dies b^ause 
he was not bled early : while in the other 
form of the disease, he dies more quickly, 
because he was Hed at alL We some- 
times meet with cases of a mixed cha- 
racter, which are difficultto distinguish. 
The condition of the patient (Holt) in 
the next case, seemed fully to justify the 
use of the lancet; in feet the morbid sensi* 
bility of the belly o^n predsure, with 
warmth of suriace and spasms ; at so early 



CHOLERA. 143 

aperiod afterthe commenbementof syinp- 
toms of the tli^^ease, seemed to demand 
the loss of blood : still ihe first effects 
of the depletion were unfavorable, and 
its ultimate result destructive. A large 
proportion of the Cholera cases which 
commenced within a day or two of this 
man's attack, proved fatal, by the rapid 
accession <>f coldness and collapse. 

Case XX.— -W. Holt, H. C. Artillety, 
^t. 20, of middle size and light com- 
plexion, recently arrived from Europe, 
and la^nded from the Ship Thames five 
days ago Admitted into Geneiral Hospi- 
tal, at half-past 2 p. M. on the 20th May 
1826: affected with vomiting, and a 
purging of a pale and almost clear watery 
fluid. He vomited the instant he was 
taken from thedoolie and plfteed on a 
bed ; and was then suffering from cramps 
in his legs : the skin was warm ; pulse 
122, soft and low; tongue warm, moist, 
and white ; belly rather full and doughy, 



144 CHOLSRA. 

pressure over the abdomeir was painful^ 
and he complained of ardent thirst. Hi's 
illness commenced at 10 A. M. with a si- 
multaneous vomiting and purging, for 
which he took medicine in the Fort. 

y. S. ad i XX. statim. 

Twelve ounces of blood flowed in a 
stream ; the rest was obtained by pressing 
the arm. The vomiting recurred while 
the blood was flowing : at the same time 
the pulse sunk, and became impercepti- 
ble, and could never be distinctly felt 
afterwards. 

A large blister was applied to the belly. 

Calomel 3 i. was put on the tongue in 
powder; and washed down with the following 
mixture. 

Tinct. Opii 3 i.«— Tinct. Sennae. 3 iv. 

An enema was ordered, composed of 

Ol. Terebinth.*-i01.Ricini — Magnesie 
Sulph. aa i ii. 



dUOLSRA. 145 

01. Cseton. gtt. i v.— Aquae Tepid. 3 x. 

4 t. M. — ^Has vomited several times, . 
and pm-ged once, a watery fluid as before ; 
he lies in a state of extreme anxiety, the 
surface livid and cold ; fingers shrivelled, 
eyes sunk, and pulse not to be felt. 

After this, no medicine remained many 
minutes on the stomach. Calomel com- 
bined either with purgatives, or with 
opium, was quickly rejected. The enema, 
was repeated, and we attempted to alle- 
viate the torpor of the venous circula- 
tion in the extremities, by keeping peo- 
ple constantly employed, with warmed 
hands, to champoo and rub the whole 
surface of the body. Brandy with hot 
water, and hot sago, were repeatedly 
given, and every means tried to restore 
the circulation, but without effect. The 
fulness of belly was decreased ; and on 
pressure the gurgling of fluid in the 
intestines was very evident. His coun- 



146 CHOLERA. 

tenaaoe ircmatned -glmst^ rattd sutik, and 
his expressions were incoherent at eight 
o'clock. He died at half-past 9. It was 
exceedingly distressing to see a patient 
sink so rapidly, and the pulse ikil so im- 
mediately on the abstraction of blood, aa 
to leave no doubt that tie treatment was 
injurious. I have seen several cases of a 
similar description, where the abstraction 
of hlood decidedly did harm, in the early 
stage of pure congestive or blue Cholera : 
hut in this instance^ the warmth of 
surface, with morbid sensibility of belly 
when pressed, and the existing spasms, 
"seemed to afford reasonable hope that 
V.'S. would be beneficial. 

Oase XXI.— -Thos. Marren, Mt 50^ a 
sailor of the Ship Bridgewater. Admit- 
ted into General Hospital, 3d June 
1830, at 10 A.M. A large and muscular 
man, of dark complexion : was taken ill 
at 8 o'clock la6t night with cramps in his 
legs and belly. Votaiting and purging 



CHOLERA. 147 

began at 1 o'clock tliis ^uoriiii;^ ; and lie 
£iay« he was bled to a basinful (pri^AmUy 
a pint) ^t 4 a. m. ; bvt has not i^eu oay 
medicine. On admission at |0 'Okdpei^ 
the fingers were shrivelled ; surface cold ; 
iongue ^old, <dajiuny) and pale ; eyes 
sunk ; pulse 162 and very weak; h^ was 
exceedingly restless, and sujOfering fronsi 
cramps in his legs and hands ; vomiting 
and purging a watery fluid, a^d ^^iUng 
aloud for drink. The beUy was BaJt^ 
doughy, and inelastic. 

V.S^adJxv. 
R. Calomel. 9 i. 

Extract, tUolocyntli. Comp. gr. vi. 
or. Menth. Kp. gtt ii. To be ghreti in pills 
now ; and^repeated. every 'hoor, .for four doses. 

Aqu9 Tepid. 3 ii.— -misce, to be drank after 
each dose of the pills. 

2 P.M. — Blood not bufFy; he has had 
one scanty stool resembling barley- 
water, but no vonutjd:^ since the bked- 

h2 



146 CHOLERA. 

ing, The pulse is not perceptible; 
otherwise he remains much in the same 
state; cramps at times violent; extre*- 
mities cold. 

A hot-water blister was applied to the 
scrobiculus cordis, and another to the 
ijcntre of the spine. 

» 

No favourable symptom occurred, and 
he died at 5 p.m. 

Dissection. — Fourteen hours after 
death, and 2 1 hours after the commence- 
ment of the disease. Venous congestion 
of the brain, some milky serum effused 
between the arachnoid and pia mater, at 
the upper part of the hemispheres ;— and 
3 iiss. of serum in each lateral ventricle. 
Nearly an ounce of serum beneath the 
tentorium, some of which extended down 
the spinal canal. 

An opaque patch on the anterior part 



CHOLERA. 149 

of the heart, evidently not the result of 
recent disease. Liver rather large, soft 
and unctuous, its surface slightly mot- 
tled. Two very white patches on th$ 
surface of the liver near the ligamentum 
suspensorium, from effusion of coa- 
gulable lymph beneath the peritoneal 
coat; these are each the size of half a 
rupee, and evidently not the result of 
recent disease. 

Gall-bladder distended with bile of a 
pale dirty green colour. The cystic duct 
not one-fifth of the usual size, and it 
arose from nearly half way up the side 
of the gall-bladder. Omentum and small 
intestines very vascular ; the coats of the 
latter, as well as of the stomach thick- 
ened, the interior of both lined with a 
thin pale-grey fluid, of the consistence of 
thin mucilage. 

Casb XXII.— .Thomas Holme» SX, 
45, a sailor of the Ship Bridgewater, was 



150 CHOLERA. 

itdmttfed mtd General Hospital at nootk 
<ftt th^ 9th Jtoie, 1830. A stoiit man; 
odT Eght coitaplexkm ; has been drmk- 
ittg lipiritis intemperately : i^ei^ed with 
VtMffttlttg; ftnd ptli-ging, and cramps in 
tfie legs at 4 A.M. These symptoms 
cf^ntiiiiie, with a flushed face, and pain in 
Memttclf and right side. Pulse frequent 
aincf fiiH, body warm, feet cold ; tongue 
white, moist, clammy, and warm. . 

V. S. ad«*lb. is8» 
Be. Calomel. ^ i. — ^Extract. Colocynth. Coxnp* 
3 ss. 
01« Ciifnaifiioii. gtt. iv. in th^ee pills. To be 
takfibfMW. 
R» 8ptk Anntion* Aromat. S i. 

AquflB Tepid. J L misce^— -to drink after the 
pills. 

Half past 1 p.Bft.-^The Ueeding made 
hitt&iiit; blood buffy, and much cupped, 
pain alleviated ; he is cold and appears 
to be sinking. 

Hills repeated, flot brandy and" water to 
b^ giv6ii« 



CItOLBRA. 151 

Half-past 2 p.m. — Vomited onte; but 
has had no stool. 

Repeat the pills^ with addition of one drop 

of Crelbn Oil» 
Jildo let him have a purghig Bheimft with 
OL Terebin&k i m. and repeat it in half an 

hour. 

Half-past 3 p.m.— He had two copious, 
dark-gteen, fluid stools, after the second 
enema ; he is now warm and more tran- 
quil ; has cramps in the feet, but has not 
vomited in the last hour. 

R* Ol. Ricini 3 i. Ol. Menth. Pip. gtt. iv. 

Sacchari 9 i. — ^Aquss Font. 3 iv. misce — ^to be 

taken now^ and repeated at half-past four* 
Turpentine Liniment to be rubbed to the 

extremities. 

6 p. M.'— He remained easier for above 
an hour ; and in the last half-hour has 
had several black watery stools, altoge- 
ther three pints ; he suffers from great 
anxiety, and incessantly calls for drink i 
tongue cold and clammy. Pulse I2& 



152 CHOLERA. 

and weak ; cramps very urgent ; fingejs 
shrivelled, 

R. Calomel. 3 i. 

Extract, Colocynth. Clomp, gr« yi, 

Opii gr. i^ to be taken in two pills now ; 

— and repeated at 7 o'clock. 
3 iv. Sago, and Brandy 5 i« to be drank after 

the pills* 

10, P.M. — Has been gradually sinkings 
and becoming more cold. Pulse now 
imperceptible ; he had one stool, the 
same sort as above ; has not vomited ; 
says his "head is light." 

Repeat the pills as at 6 p.m. 

Also let him have Spt. Ammon. Aromat. 3 

iss. 
Aquae Tepid. 3 "• — ^ be drank after the 

pills. 

Died half-past 11 p. M, 8th June, 
f830. 

Dissection. — Fourteen hours after 
death. Subject stout; eyes much sunk, 
and face very white. 



CHOLERA. 153 

Some old adhesions were observed in 
the right side of chest; both lungs sound, 
their posterior part very dark-coloured, 
from gravitation of blood. Liver large, 
soft, and exceedingly vascular, its surface 
covered with star-like patches of vascu- 
larity, like the nose and cheeks of a bon- 
vivant; incisions into the liver bled 
freely. Gall-bladder small ; its coats 
thickened; its base adherent to the 
colon. Stomach thickened and pale ; 
its interior corrugated, and covered with 
thick whitish mucus. Omentum and 
small intestines very vascular : the coats 
of intestines somewhat thickened, and 
their contents deeply tinged with dark 
orange-coloured bile. Veins of brain 
turgid ; much effusion of serum between 
the arachnoid and pia mater — in some 
places this effusion very milky; 3 vii. 
of clear serum in right lateral ventricle, 
above an ounce of clear serum in the 
left, and 3 iii. beneath the tentorium : 
the substance of the brain was firm and 
tough. H 3 



154 e*it!yt*ttA. 

Ckm XXm.--Jafli^s McCdbe, Mi. 
2fS, A ^ttt Man, of d&l-k eothpleltkm ; 
fbnf ytJa*!§ lit Indfer, recently arrive frdm 
M4df^d t havii^ vblunteeterf from H.M. 
89thf to the 3d foot ; and theriftfore it 
ittay be presumed, he has been living in 
an irregular and dissipated manner for 
the greater part of several weeks past. 
Was admitted into General Hospital on 
the evening of 11th Noteihber, 1830. 
IH five days with head-ache, and griping 
in the belly. Was bled to lb. iss. that 
night, and the blood was not buflfy. In 
the next three days, he took two doses 
of Colocy nth with blue pill ; and one dose 
of castor oil^ which purged him freely. 
He was discharged well on the 15th 
Ndvembet. 

This ftlan was seized on the next day 
with vomiting, after eating his dinner at 
three o'clock ; atrd was sent ta the Hod- 
pital kt 6 o^dock P. M. on the 16th No- 
vembejf. Me was then vomiting with 



CH0LBRA. 153 



great viokxice, and constaatiy passing by 
dtool a eoiiJ€SB*tike SwA, widi white* floo- 
cull: the suifaCe of fais body va» coid^ 
pidse feeble ; and be had siigfat cnonps 
in the kgs. 

V. S. ad lb. L 
H. Calomel* 9^ u 

0]pi} gt, i. to be taken ntttttedlately in apill. 
BBtttemilies f tibfotd tHtb OL Tesebitiib. 

Eight o'clock T. M.— Only 8 oz. of 
blood could be got firom. the veins* No 
change for the better ;. he hast jtist now 
vomited, and had a stool like conjee. 

]^. CsEdomd. S> i. in pAh, to be vd^ed down 
tiitik tMs dMught* 

R. Spirit. Ammoniflr Aionatr^Tinetone Opii 
aa 3 i. 

Aquae Cinnamoni i L misce— the draught 
and pills to be repeated at 10^ and again at 12 
o'clock. 

He gradually siHik into a state of in- 
sensibility, and died ait one A. M. 17th 
November^ 1830. 



156 CHOLERA^ 

' Dissection. — Fourteen hours after 
death. Much engorgement of blood at 
the back part and root of the. lungs^ 
Liver appeared healthy, and rather 
smaller than common; its edge thin^ 
and texture of natural softness. The 
gall-bladder was full of green bile ; its 
exterior covered with an adventitious 
membrane, apparently not of recent for. 
mation. Stomach and small intestines 
enormously distended with flatus, and 
containing much whey-like fluid, and 
thick white mucus. There was no bile 
in the duodenum. Omentum, mesen- 
tery, and mesocolon, highly vascular; 
small^ intestines in the same state, me<» 
senteric glands enlarged. 



Arteriotomy in Cholera. 

When plethoric subjects labouring 
under Cholera, fall early into a state of 
collapse, with obstructed circulation; 



CHOLERA* 157 

and we are unable to take a considerable 
quantity of blood from the veins ; we are 
apt to suppose that the measure fails to 
afford relief, because we do not get 
enough blood : and it is difficult to come 
to a different conclusion, when we con- 
template a robust and ][)lethoric man suf* 
fering from that form< of Cholera, with 
the &ce, neck, and chest purple or livid ; 
while the patient is using great muscular 
exertion in respiration. But when we 
open a. considerable artery in. such sub- 
jects, and take blood as freely as we 
could wish : and still find our patient not 
relieved, we are obliged to change our 
opinion. Some doubt may be entertain- 
ed with respect to the propriety of taking 
blood from an artery, in those cases, ob- 
serving that the congestion and obstruc- 
tion appear to be in the veins : and in 
taking away arterial blood, we deprive 
the patient of that which his systenv 
cannot again supply, so long as the de- 
carbonising functions of the lungs are 



158 CHOLERA. 

arrested: either in consequence of thtt 
disorder of the nervous system greneral* 
ly, or by means of a morbid coaEttng: of 
viscid mucus in the bronchial tubes and 
air cells. We are so apt to speak of the 
calorific and decarbonising functions of 
the sysrtem^ ag allied to each other, that 
perhaps. I may now be ascribing too mndi 
to the latter ; when I wo«ild speak of the 
Mlure of both, as among the most pro« 
minent phenomena of declining vitality, 
in cases of Cholera with collapse. 

Ca« XXIV.— William Griffitha, a 
Gunner in the Artillery, aged 28^ a stout 
muscular man, four years in India, in* 
valided on aodoimt of the loss of an arm ; 
and recentiy sent irom his battalion to 
Fort William, on his way to Europe. 
Was taken ill with Cholera soon after 
midnight ; the first symptoms were vo- 
miting and purging, followed by dreactful 
thirst, cramps in the l^s, coldness of 
the whole surface, and eiitreme an:tfety. 



CHOLERA. 150 

He did tw^t report his illtieds till ddy- 
light, ^nd wte then sent to Hospital, 20tlk 
December, 1829. On admission, he was 
quite cold, the fingers shrivelled, puli^ 
imperceptible ; tongue cold, moist, clam*^ 
my, and nearly clean ; the ftice livid ; 
eyes sunk in the orbits ; and there tiras 
much venous congestion of the eyes^ 
givii^ the scleroticee and conjunctivaa a 
lurid appearance. Res'piratson was la- 
borious, and the chest heaving, with ex- 
pression of great agony in the counte- 
npince : voice pectoral, but not very 
feeble. He was tossing from side to 
side in bed, and constantly calling for 
water. Cramps in the legs and arms 
very severe. 

Twenty grains of calomel and two 
graiiis of opium were given in a pill, but 
immediately rejected. A free incision 
was made into- a vein in the arm, but not 
a tea-spoonful of blood obtained-; the 
jugular vein was then opened, and only a 



1 60 CHOLERA . 

trivial oozing of thick black blood, like 
treacle, issued slowly from thence. 
These attempts to procure blood from 
the veins haying failed, and the symp- 
toms continuing unabated, he was ordered 
to take 20 grains of calomel mixed with 
sugar, and washed down with the 
following draught : 

R. Aquae Cinnamon. § iss.— Spirit Ammonise 
Aromat TincU Opii aa 5 i. misce. 

These medicines were vomited up^ 
with most violent efforts, the instant 
after being swallowed. The extremities 
and body were now rubbed with spirit of 
turpentine, by four men ; and at the same 
time the radial artery was freely opened 
at the wrist, by an oblique incision with 
a lancet; the integuments being first 
divided down to that vessel, with a small 
scalpel. Blood flowed from the artery 
at first in a languid stream and of dark, 
purple color, trickling down the wrist. 
When about 13oz. had flowed, the blood 
came in a jet with arterial impulse, its 



CHOLERA. 161 

colour was rather brighter red ; yet not 
like the arterial blood of a healthy per- 
son. At this time there was no evident 
relief of any symptom, and the man said 
he was weaker. The rubbing of the 
extremities was continued briskly, and 
a finger applied to arrest the flow of 
blood. Some brandy with hot-water was 
given, which he vomited immediately; 
and after this he refused to take any 
thing but cold water: in fact he was 
totally unmanageable, and deaf to ar- 
gument or entreaty of his friends. After 
the delay of about three minutes, the 
blood was allowed again to flow, and 
it came freely with a smart jet ; by which 
and the restlessness of the patient, above 
4^ oz. was spilt on the bed and floor ; 
when. lb. j. more had been received in the 
basin, the stream became smaller and 
more feeble, which was ascribed to the 
gradual formation of a coagulum at the 
orifice ; but the man seemed weaker and 
more exhausted. Therefore the finger 



162 CHOLERA. 

was again applied to the artery for five 
minutes. The patient was now evi- 
dently more purple in the face, his 
breathing more laborious, and he ap- 
peared more feeble in tossing about in 
bed: the voice remained pectoral, but 
much weaker than on his arrival at the 
Hospital about one hour and a quarter 
ago. The principal distress appeared 
as this time to depend on the stagnation 
of venous blood, and imperfect action 
of the lungs. The artery was again let 
loose; but the blood now flowed very 
feebly, and only 3 ounces more could be 
procured. 

During the above treatment, this pa- 
tient continued sinking ; but I could not 
assert, that his dissolution took place 
more quickly than I have frequently 
seen in patients admitted in the same 
stage of disease, who had the calomel 
and opium treatment, with stimulants, 
and who were not bled. Although the 
blood sprung from the arm in a smart jet 



CHOLERA. 163 

before a pound had flowed, and we might 
infer from hence that the heart's aetion 
was more free, I was never able to dis* 
tinguish any pulsation in the radial 
artery; nor did the patient appear in 
any degree relieved. The blood re- 
ceived in three cups as above stated, was 
examined in half an hour; it had eo* 
agulated rather more firmly then we 
find the cruor of venous blood of a healthy 
person, its color, not materially differing 
in the sereral cups^ wa» of rather brighter 
tint than the cruor of healthy venous 
blood. Wh^ carefully weighed, the 
quantity taken in the cups was found 
to be lb. ij. 1 oz. making together with 
what had been spilt in consequence of the 
arterial jet, and the agitation of the 
patient, 2 lb. 5^ oz. No serum was 
separated in any of the cups of blood. 
The patient gradually became weaker, 
less agitated and indifferent to sur- 
rounding objects; occasionally calling 
out that he had cramps in the feet or 
belly ; no sign of reaction appeared, and 



164 CHOLERA. 

he died one hour and 37 minutes after 
the blood had ceased to flow from the 
artery^ 

Case XXV. — ^Pierre Louis, a middle* 
size lad, of light complexion, Mt. 18, a 
French sailor, of the Ship L' Indus ; was 
brought to Hospital at 5 P. M. on the 21st 
March 1828, having suffered from slight 
fever for six days. He began . to vomit 
yesterday morning, and was 20 times at 
stool since : evacuations like water. Vo- 
miting ceased during the night, but re- 
turned this morning, since which he has 
vomited three or four times, but had no 
stool this day. Has now severe head* 
ache and pain atscrob. cordis; pulse 108 
and feeble ; respiration panting and 
anxious ; pupils dilated, bu there is no 
venous congestion of the eye-balls ; sur- 
face of the body cool ; the tongue cold, 
moist, and white. He is suffering from 
dreadful thirst. He has taken no me- 
dicine, and for two days past no food. 



/• 



CHOLERA. 165 

Apply 12 leeches to the Epigastre^ and six 
to the temples. 

Calomel 5 ss: was given in pills: and a 
draught of 

Tinct. Rhei 3 iv. Aquae Cinnamon. J i, . 

A blister was applied to the belly^ and at 6 
o'clock he was ordered to take 

01, Ricini— 01. Terebinth, aa 3 i. with 01 
Croton, minim ii.' 

At 9 P.M.— The face is livid, tongue cold, 
pulse at wrist imperceptible, and fingers 
shrivelled ; the hands quite purple from 
stagnation of venous blood : he calls in- 
cessantly for drink. Has been once to 
stool, and voided from the intestines 
a small quantity of clear water, which 
has a peculiar cadaverous odour. 

Repeat twelve leeches to the chest; and 
BiT^ to the temples. 

. R. Calomel. 3 i.— Extract. Colocynth. Comp. 
9 ss. 

Opii. gr. ss. — ^misce fiant pil. iii. statim su- 
mend ; also let him have 

Spirit. Ammonias Aromat 3 i. 

Aquae Font. 3 i. in a draughty after the pills. 



166 CHOLERA. 

At 10 P. M.— -No vomiting, nor stool ; 
cramps very severe; thirst titiBl>ated: 
pulse just perceptible and very rapid. 
His face continues purple, und respira- 
tion laborious ; the chest heaving, with 
intense anxiety. Seven of the leeches 
have filled tolerably, the rest have been 
pulled off by the constant restlessness and 
jactitation of the patient. A vein was 
now very freely opened, but no blood 
fiowed. As a last attempt to mitigate 
the extreme agony of the patient, I made 
an incision down to the radial artery at 
the wrist ; and opened that vessel by an 
oblique section with a lancet. The blood 
which first flowed was warm, and of a 
purple colour ; it trickled down the arm 
for a few minutes, and afterwards started 
forth with a jet, and by the time seven 
ounces had flowed, the arterial impulse 
was strong and steady : the livid colour 
of the face had decreased, and there was 
less laborious heaving of the chest ; but 
the coldness of surface remained, and 
there was no perceptible difference in the 



CHOLERA . 167 

pulse at the wrist. Desiring to afford time 
to ascertain if iMs limited flow of blood 
from the artery, would be fcdlowed by. 
acknowledged relief of respiration, and 
more free action of the heart and arte- 
ries : pressure was made on the orifice 
for five minutes, as soon as seven ounces 
had flowed. The patient not expressing 
any relief at this time, the orifice was al- 
lowed again to bleed, until seven ounces 
more had flowed, and after a similar 
pause of five minutes, the bleeding was 
carried to 21 ounces, besides about fiv« 
ounces that were spilt on the bad and 
floor. The colour of the blood last 
drawu, was more florid than the first, but 
the patient did not appea^r to derive any 
benefiit from the opertiil^ion. He was 
weaker, and as it was eatimiaied tliat he 
had lost by V. S. and leeches, abov^e fifty 
ounces of blood since admission ; ihe 
artery was closed with €;light pfesBure 
and a bandage. The patient swallowed 
20 grains of oalomel in a small quantity 
of beer, which was the only thing he 



168 CHOLERA. 

would now take: and the calomel was 
repeated at 11 o'clock, but not the 
slightest amendment took place, and he 
died at ^ past 1 2 at night. 



The low form of Cholera with 
tendency to collapse. 

In the succeeding cases, we have ex- 
amples of a most formidable description 
of Cholera, from which the patient seems 
to have no chance of recovery by the un- 
aided eflForts of nature. V. S* at the 
commencement of collapse is a dange- 
rotis experiment, which has often done 
harm in such cases; but we frequently 
succeed in saving our patients, by a 
careful and judicious treatment. Febrile 
and inflammatory symptoms are not 
usually observed in persons suflFering 
from this description of Cholera ; and 
early failure of vital energy, seems in 
many cases connected with profuse and 
frequent watery evacuations ; the course 



CHOLERA^ 169 

of the disease tending? rapidly to that 
stage of torpor, in which remedies pro- 
duce no eflFect. 

It is when this description of disease 
occurs in the cold season, that we most 
frequently see the short and imperfect 
respiration, with feeble pectoral voice, 
and other symptoms, indicating that tor- 
por in the functions of the lungs, which 
dissection proves to be sometimes con- 
nected with a thin coat of tenacious mu- 
cus, on the surface of the bronchial tubes 
and air cells. Among the expedients 
that might reasonably betried in this form 
of disease ; the inspiration of medicated 
vapours, and of nitrous oxide gas may be 

• 

mentioned. In fact, the eiSects of reme- 
dies inhaled into the lungs, have been 
almost entirely neglected : they may be 
useful in the treatment of this formidable 
modification of disease. 

Cabe XXVI.— Joseph Branch, iEt.42, 

1 



170 CHOLERA^ 

a midcUe-si;;ed man, wius affected with a 
slight diarrh€^a, on the 24th and 25tb 
April 1826, to which he .paid no atten-< 
tion ; the purging increased, and on the 
26th at daylight he began to vomit, but 
concealed his ailments until they were 
observed by one of the seijeants, and he 
was sent into the General Hospital at 8 
P.M. he was then vomiting very fye^ 
quently, and was piurged every half*hour; 
the stools were copious and watery, and 
be was suffering from cramps in the 
toes : the pulse was soft, ^^eak, and rapid, 
^nd he had the Cholera visage. 

He was ordered to take three grains 
of opium in a pill, and to repeat the dose 

at 10 P.M. 

» 

April 27M— At 6 a.m. He is &ow 
free from cramps, vomiting and purging 
have ceased ; he is very weak, but the 
pulse is soft and natural, his tongue is 



CHOLERA. 171 

w^rm, moist and coated with a litllo 
white mucus. 

R. Extract. Colocynth. Caaxp* 
Calomel, aa gr. v. 
Opii gr. J. — misce fiant pil. ij. statim 

suinend. 

Ordered 8 oz. of Port Wine in Sago ; and 

allowed Tea. 

Meridie. — ^The vomiting and purging 
have returned ; the stools are like rice- 
water; his skin is again cold, hut the 
tongue is warm; pulse 102, soft and weak, 
and he suffers from slight cramps in the 
legs. The return of symptoms is as** 
cribed to his having drank much water. 
Three grains of opium were ordered to 
be taken immediately, and to be repeated 
at 3 o'clock. 

Vesper. — ^At 6 p. m. He has only vomit- 
ed twice, and the purging is moderated ; 
he is warmer and feels better, but com- 
plains of extreme thirst ; pulse as .above 

I 2 



1 72 CHOLERA. 

reported. He was ordered to take two 
grains of opium dissolved in half an 
ounce of tinctiure of senna, with one 
ounce of chuiamon water, and a drachm 
of Spirit. iBtheris Nitrosi. 

April 28/A— He slept and is much bet- 
ter ; has not vomited during the night, but 
has had two frothy fluid stools of nearly 
white colour. 

R. Extract Colocynth. Comp. 
Calomel, aa gr. v. ter die. 

T^jrper.— He has had several yellow* 
ish frothy watery stools in the course of 
the day, and is now suffering from nau- 
sea, and inclination to vomit. 

R: Extract Colocyntli. Comp. 
Calomel, aa gr. y . 
Opii gr. i. misce fiant piUstatim. 

April 29th. — He had three stools in the 
course of the night ; they are of a light 
colour and frothy. There has been no 



CHOLERA. 173 

vomiting. Me is wann, and the circula- 
tion natural, the tongue is clean and 
moist. 

Ordered to take twenty grains of Rhu- 
barb, with a drachm of magnesia, in cin- 
namon water. 

April 30th, —He had five stools in the 
course of yesterday forenoon,' and had 
neither vomiting nor purging since: 
slept well, and the pulse is now natural, 
tongue warm and moist. After this date 
he took a mild purgative almost every 
day, until he was discharged on the 15ih 
May 1826. 

Case XXVII.— WilUam Prosser, JEt. 
27,. a stout man of dark complexion, 
was taken ill at 1 a: m. on the 2 1st April 
1826, and had three very copious watery 
stools before daylight; after which he 
was purged at least ten times in each 
twenty-four hours, and vomited as often, 



174 CHOLERA. 

until the morning of the 23d. Admitted 
into General Hospital at 9 A. M. pn the 
24th April ; the vomiting has ceased, hut 
the purging continues, the evacuations 
resemble clear water.^ The extremities 
are cold, his belly is flat and inelastic, 
pulse 96 and not very weak; tongue 
white, moist, and warm ; but the Cholera 
visage is strongly marked. He has had 
ispasms in his legs which have now 
ceased, and he is very weak ; but as the 
doolies were all employed, and he was 
anxious for immediate assistance, he 
with some difficulty walked to the hos* 
pital, a distance of nearly a mile. 

R. Opii gr. iii. — Aquse Fontis 3 i. 

Spirit Ammoniffi Aromat. 5 iss. misce. 
To be taken immediately. 

Vesper. He has had two stools, like 
barley-water ; is free from spasms, but 
very thirsty and restless, pulse 106 and 
weak : the tongue is cool, and the eyes 
are sunk. 



gaoleaa. f7$ 

f 

a. Bxtraet. Colocynth. Comp. 9 ««. 
GalomeL 9 u Opii gr« i. 
Olei Croton gtt. ii. to be taken in three pills. 

April 25th. — He has had five stools in 
the night, which are in appearance like 
conjee : he has been vomiting, but his 
pulse is not very weak. 

Be. Puly. Scammon. Comp. (Ph. £d«). 
Pulv. Jalap.— Pulv. Rhei aa 9 i. 
Tinct. Sennae. 

Aquae Cinnamon, aa 3 ss misce. 
To be taken at 6 a h. 

At 9 A. M. he had been vomiting often 
but had not been purged, was ordered 
to take SO grains of calomel with ten 
grains of compound extract of colocynth 
and one grain of opium. 

Noon. He has vomited, and had two 
Cholera stools : he is now quite cold, and 
appears to be rapidly sinking: the pulse 
is feeble. Four grains of opium were 
given in a pill ; three ounces of brandy 



176 QIIOLBRA. 

were mixed with six otifaces of hot water, 
and small (juantities frequeutly taken. 

At 2 o'clock he remained very low 
and weak, therefore 3 ounces of port 
wine were ordered, in hot sago. 

Vesper. Vomiting and purging have 
ceased; he is warm, and free from 
spasms, pulse low. 

# • 

R. Extract. Colocynth. (?oiDp. 
Calomel, aa gr. v. — Opii gri i. 
To be taken in pills. 

April 26th. He has had no stool in 
the night ; appears much better, and the 
warmth of surface continues. 

The pills ordered last night, are to be 
repeated three times a day. 

April 9,Tth. He has had one natural 
stool ; the gums are slightly sore. 



CHOLERA. 177 

R« Extract Colocynth Comp. gr. x. 

April 28M. He had one stool in the 
night, of healthy appearance; and is 
nearly free from ailment. The extract 
of colocynth was repeated. 

April 29M. He has been purged 
once ; the tongue is clean and moist* 
and he feels well. 

R. Pulv. Rhei 3 ss. 

In Aquse Cinnamon. 3 i- 

May 3d. Discharged, to proceed with 
his detachment up the river in boats. 

This man's case appeared nearly hope- 
less for thirty-six hours after admission 
into Hospital. I have never known so 
much opium required to check purging 
and vomiting, in any other case, which 
ultimately recovered. It is probable that 
eleven grains were retained in the sto- 
mach, from the time of his admission 

I 3 



178 CHOLERA. 

into hospitaK up to tiie evenmg of 26£h 
April, including a period of about sixty 
hours. 

CaseXXYIIL John Simms, ^t. 24, 
of smaU size and light complexion, six 
years in India, an artillery-man, was 
taken ill at 7 p. m. on the Battery guard, 
and sent to hospital at 9 o'clock, affected 
with purging, vomiting, ^nd cramps in 
his legs : the pulse at wrist had ceased 
before he reached the ward, and the sur- 
face of the body was quite cold; his 
tongue was cold, voice pectoral, and he 
was suffering from thirst to such a degree 
as to be indifferent to everything but the 
desire to drink, hardly giving any answer 
to questions. 

Twenty gmins of calomel were given 
in powder, an4 washed down with a 
draught composed of 

Spirit, ^theris Sulphuric. 
Tinct. Opii aa 3 i. 



CHOLERA. 179 

Oleum Cinnamon, gtt. hr« 

The calomel and draught were repeat- 
ed in an honr. 

At faidf past 10 o'clock, he was cold 
and insensible ; respiration heavy and la- 
borious ; vomiting had ceased. Died at 
11 p. M. 14th November, 1830. 

£^<sec/io»'— Nine hours after death : sto- 
mach externally paler than usual, inter- 
nally towards the pylorus of a pink colour, 
and much contracted. Small intestines 
of a pale pink colour, their coats thick- 
ened and pulpy, as if from serous efiusion 
between their membranes : their interior 
filled in some parts with great quantities 
of conjee-like fluid, in other parts with 
mucus as thick as paste ; the last foot of 
the iiima was quite empty, contracted 
and dry : no bile in the duodenum. No 
other mothid appearance observed. 



ISO CHOLBRA. 

Case XXIX. — A medical man, 26 
years of age, of slight make and delicate 
constitution, recently arrived from Eng^ 
land, had a severe attack of spasmodic 
cholic, within a few weeks after landings 
in Bengal: the constipation attending 
this disease was most obstinate, and du- 
ring the treatment he was twice largely 
bled from the arm, and leeches were re- 
peatedly applied to his belly. After 
various purgatives had failed, the ob^ 
struction of the bowels was removed by 
large enemas given with the pump. He 
remained in the course of a tardy conva- 
lescence for six days more ; using little 
mild purgative medicine, and observing 
the greatest caution as to his food, but 
gaining strength so slowly, that on the 
evening before the attack of Cholera, 
when some friends asked how he was; 
he said this was the first day since his 
illness, that he really felt an increase of 
strength. At 9 p. m. on the 27th Octo- 
ber 1830, he was aflFected with a purg- 



CHOLERA. I 8 1 

iiig, the stools copious, watery, and of a 
pale^yellow bilious tinge. He did not 
send for advice till next morning, not 
suspecting Cholera; h,e had then sunk 
into a state of collapse, affording no 
hope of recovery ; though he had not vo- 
mited, and had no spasms. Occasional 
attacks of vomiting took place during 
the course of the day, and he died in the 
afternoon. We had some bad cases 
of Cholera in the Hospital at that time, 
but the patient had not left his room 
for near three weeks* The disease was 
also occurring in Calcutta. 

Case XXX.— Thomas Price, Mt. 32, 
a stout man, of H. M. 38th Foot, ar- 
rived from England on board the ship 
Buckinghamshire, and landed on the 2d 
June. Admitted into General Hospital 
at 10 p. M. 14lhJune, 1827. Has been 
purged for two days past, but did not be- 
gin to vomit until he was put into the 
dooley to be brought to Hospital. Is at 



182 cholsrjl. 

present vomitiog, and purged inoessant- 
ly t and suffers from distresfiong ihamt 
Pulse 106, and hardly perceptible ; sur* 
fece of the body a$ well as tilie tongue 
cold. 

a. Calomel. 3 i. 

Opii gr. ii* misoe fiant pil. ii. statim sumen- 
dae. 

Apply a blister to tixe scrobiculus onrdis. 

Up. m. — ^Purged twice; evacuations, 
a pale greenish water : he is constantly 
vomiting ; tongue cold, moist, and clean 5 
great anxiety and thirst. 

R. Calomel. 3 sb. 

Opii gr. ii. misce fiAiit ftti. statun aumend. 
Apply SinapiamB to the feet 

Jtme I5tk. — Vomited only twice^ and 
purged five times since last import; 
evacuations watery ,^ and of pale-green 
colour : he is much better, and quite com- 
posed; tongue warm and moistt but 



CHOLSRA. 183 

little furred ; pjske 108 and ireak. Some 
Baigo and wine attowed. 

Be. Caloniel, B ss.—^Extract Colocynth. Comp. 
gr.v. 

Opii gr. \ — ^misce fiant pil. ii.— to be taken 
at 6 A. M. and repeated at 10 o'clock. 

Ol. Ricini J i. atnoon. 

Vesper.' — ^He is better, and warm; had 
four stools but no vomiting. Pulse 1 12 
and weak. 

R. Extract. Colocynth. Comp. 
Pil. Hydrarg. aa gr. v. 
Opii gr. i. misce fiant pil. ii. h. s. sumend. 

June 16th. — Has had frequent, brown, 
watery stools ; and much nausea in the 
night. Pulse 98, &ce flushed. 

R. Pil. Hjdrarg. — ^Est^paot Colocyntfa. Comp. 
aagr. v. 

June 17M. — Had five stools;, a slight 
degree of pyrexia remains. Pulse 98 ; 
skin warm ; tongue swollen and fissured. 



184 CHOLERA. 

R. Extrect Colacynth. Comp. . 

Pil. Hydrarg. aa gr. vi, in pills, at 6 a. h. 
01 Ricini J i. at noon. 

By these medicines he was freely 
purged, the evacuations were of dark 
colour, and he was much better. Castor 
oil was administered daily, and he was 
discharged well on the 20th June. 

Case XXXI.— Mrs. Ann Holt, iEt. 
about 24f, landed from England on tlie 
12th May, 1827, and was troubled with 
vomiting almost every day till the 18th, 
when I first saw her, at 1 1 p. m. Her 
pulse was then 1 04 and weak ; tongue 
cold ; she had been vomiting, and 
purged violently since dark ; and her ex- 
tremities were cold. 

He. Calomel. 9 i. in pills. 

R. O'pii. gr. ii. — Spirit. Lavand. Comp. 

Spirit. Ammoniffi Aromat. aa 3 i. 

Aquas Menth. Pip. J i. misce, — to be drank 
after the pills. 

May 19^A.— She has not vomited since 



CHOLERA. 185 

taking the medicine ; was purged three 
times; evacuations copious, like rice- 
water, with a light slate-coloured sedi- 
ment; tongue warm, moist, and white ; 
face somewhat flushed, pulse 108, and 
weak ; extremities warm. 

Apply eight leeches to the temples. 
R. Pulv. Rhei. 3 i. 

Aque Menth. Pip. ^ i. To be taken at 6 

A. M. 

01. Ricini 5 i. at noon. 
Tea and Sago allowed in very small quantity, 

1 P. M. — Vomited six times, but the 
castor oil was not rejected : purged four 
times ; stools copious and of a pale-grey 
colour, as fluid as water ; tongue cool, 
moist, and white. Pulse 132. 

R. Pil. Hydrarg. gr. v. 

Extract Colocynth^ Comp.. B ss — misce 
fiant pil. iii. to be given at two o'clock. 

6. P. M. No vomiting ; she has had 
six feculent black stools ; tongue wai'in. 



1B6' CHOLERA* 

and very much loaded with white 
mucus. 

R. 01. Ricini 3 L— Tinct. Opii gtt. v- 

Half-past 10 P. m. She vomited the 
oil : had two, copious, watery, hronze- 
coloured stools. Tongue warm, moist, 
and white. 

R. Extract. Coloc3mth. Comp. — Calomel, aa. 
gr.v. 
Opii. gr. i.— misce fiant pil. statim smnend. 

May 20th. Slept, and had one gr^n 
bilious stool ; no vomiting. 

R. Extract Coloc3qith Comp. 

Pil. Hydrarg. aa gr. v. at 6 a. m. 
01. Ricini 3 i* at noon. 

4 P.M. — She has vomited the pills and 
oil ; had two watery black stools ; the 
tongue is warm, and loaded wth white 
mucus. 

R, Pulv: Rhd 3 i. Aqae CSmiamon. I i. 



CHOLERA. 187 

6 F. M. — Had one stool, and has not 
vomited ; says she is better. 

Ordered to take some Sago and Wine. 

May 21st. Had no sleep; has been 
purged, and vomited often in the night, 
stools a reddish bronze-coloured water ; 
tongue cool and moist; pulse 116 and 
soft. 

' R. Opii'gr. i. statim. 

May 22d. Was tranquil, and feeling 
remarkably we\\ all yesterday, therefore 
no medicine was given in the evening. 
During the night she vomited occasion- 
ally, and had two copious bronze- 
coloured stools ; pulse 98 and soft. 

Bc» Extract Colocynth, Comp. d ss. 

Pil Hydrarg gr. v. — misce^ fiant pU. iii. sta- 
tim suxnendae. 

She was purged freely by these pills, 
and is much better in every respect. She 



188 CHOLBRA. 

had no return of unfavourable symptoms : 
some mild purgative was continued daily 
till the 29th, when no further treatment 
was requisite. 

Case XXXII. Jas. Beck, .^t. 19, a 
slight made lad, of light complexion, a 
sailor of the ship Resource, recently ar- 
rived from sea. Was attacked with 
Cholera, and profuse purging, on the 
11 th October, 1827, and in consequence 
of extreme coldness of the extremities, 
water was applied by his messmates, so 
hot that the skin was blistered on one 
foot, and also at the elbow. I could not 
ascertain what other remedies were used : 

■ 

and no cause could be assigned for the 
accession of the disease. 

On the 12th, the most distressing 
symptoms were cramps in the legs, and 
purging. He was sent to the Hospital 
at 5 P. M. on the 13th October ; suffer- 
ing from cramps in hi^ legs, anxiety, and 



CHOLERA* 189 

great thirst : he had a cold tongue, al- 
though the extremites were now warm ; 
pulse 116, soft and feeble; and there 
was pain at scrob. cordis. The eyes 
were glazed, and sufiused with florid or 
arterial congestion, the face was some- 
what flushed. He now vomited imme^ 
diately every fluid that was swallowed, 
but had only been purged four times 
since the morning. Some of the exist- 
ing symptoms might have authorised V. 
S. but the use of the lancet was at the 
present stage of the disease, deemed 
hazardous, in consequence of the long 
continued and profuse purging, feebleness 
of pulse, and coldness of the tongue ;. for 
although the extremities had been blis- 
tered by boiling water, the temperature 
of the body was not uniform. 

Eight leeches were applied to the temples. 
A blister was put to the scrob, cordis ; and 
Calomel, d i. 
Opii gr. i. were given in a pill immediately. 



190 CfiOLERA* 

9 P. M, — No return of vomiting or 
purging since 5 o'clock; the leeches 
bled profusely, whereby the flush of fiice 
and redness of eyes are diminished ; he 
suffers less ftom thirst, and the tongue' is 
warm, but pulse continues 116, weak 
and low ; cramps in the legs have ceased. 

R. Calomel. 9i. 
Opii gr. 1. 

Extract. Colocynth. Comp. gr. v. in tbree 
piUs. 

1 1 P. M. — Thirst subsided, no vomiting 
or purging since admission. 

01. Ridni 3 ii. 

Oct. 14/A.— ^Vomited once,,and purged 
three times ; the stools are as black as 
ink, and scanty; he feels much ex- 
hausted ; the pulse 104, soft and weak, 
but face slightly flushed. 

R. Extract Colocynth. Comp. 

Pil. Hydrarg. aa gr, v. in two pills*4t 7 a.m. 
and repeat at 11'. 



CHOLERA. 191 

Ordered lo take 01. Ricini 2 i. at 3 P. M. 
Diet Tea, and thin Sago, with 3 oz. PortWine. 

Vesper.-^He has vomited twice, a pale 
watery fluid, nearly transparent. 

7 P. M.— Had five stools, which are 
rather scanty, and of a very dark bottle- 
green colour; pulse 98, soft, and weak; 
tongue quite cold, soft, clean, and moist, 

B^. Extract Colocynth. Comp. 
Pil. Hydrarg. gr. v. 

Opii gr. 88. in two pills at 7 p- m. and re- 
peat at 10. 

Oct. 25fA.— Had four copious, dark, 
watery stools ; did not vomit in the 
night ; suifers anxiety, but no head-ache ; 
eyes still suffused. 

Capiat 01. Ricini J i. 

Vesper. — Vomited once, and purged 
four times during the day, evacuations 
partly of a yellow colour. Pulse 98, soft, 



.192 CHOLEitA. 

and natural ; iongtie continues quite 
cold. 

After this date, he had mild purgatives 
repeatedly, and was discharged well on 
the 12th November, 1827. 

Case XXXIII.— Mrs. Mary Ann 
Kelly, ^t. about 24, a soldier's wife of 
the 44th Regiment, received into Gene- 
ral Hospital at half-past 9 p. m»^ May 
19th, 1827: states that she was seized 
with extreme sickness at 1 o'clock last 
night, (20|^ hours ago,) at first she vomit- 
ed and was purged about once an hour, 
but lately purged every minute ; and she 
appears exceedingly exhausted. 

R. Calomel 9 8S.—0pii gr. i. statim. 

Half-past 10 o'clock. Has cramps in 
her legs, great anxiety, and thirst ; pulse 
132 and not very weak; tongue warm. 
Neither vomited nor purged since taking 
the pill. 



CHOLERA. 193 

R. Calomel. 3 i. in a pill^— -to be washed dpwn 
with a draught of. 

Spirit Lavand. Comp. 

Spirit Ammonis Aromat. aa 5 ss. 

Aqu« Menth. Pip. J i. 

May 20M. She has slept, the cramps 
have ceased, and she feels better : pulse 
86 ; had one scanty green stool. 

R. Extract Colocyixth. Comp. 
Pil. Hydrarg. aa gr. v. at 6 a. h. 
01. Ricini 3 i* at noon. 

4 p.m. No stool nor vomiting ; cramps 
in the legs have returned. 

. R. 01. Ricini 3 i. 

6 P. M. She is quiet, and easy ; had 
no stool. 

Repet. 01. Ricini J i. 

Half-past 10 p. m. She remains tran- 
quil, and is much better ; had two dark 
watery stools. 



1 94 CHOLSEA. 

May 9\tt. Had one black watery 
stool in the night, with some lumps of 
faeces ; pulse good, and skin warm ; she 
feels weak. 

R. Pulv, Rliei. 9 i. in 
Aqiue CiniiaiiioD. J i- 

Vesper. She has been freely purged, 
and is better. Mouth sore. 

May 226f.-*Had one stool, consisting 
of films of mucus in yellow bilious mat- 
ter. After this date she used rhubarb 
as an aperient, and was discharged M*ell 
on the 8th June. 

Case XXXIV. John Fergusson, Mi. 
23, a sailor of the Ship Euphrates. A 
middle-sized man, of dark complexion, 
arrived in the Hooghly ten days ago, 
from Europe; has not been on shore, 
but he and the rest of this ship's crew 
have been exposed to the sun, and 
worked hard for some days past in get- 



CHOLERA. 195 

ting up the anchors^ &e. the ship having 
met unusual difficulties in coming up the 
river. Admitted into General Hospital 
a quarter before 10 a. m. 18th June, 

1828. 

Has had a purging for five days, and 
began to vomit at 1 p. m. yesterday ; says 
he has had fifty stools, like pure water, 
since that hour. Is now suffering from 
great anxiety, thirst, and cramps in the 
belly : face flushed ; pulse low, and op- 
pressed ; tongue cool. 

Apply twelve leeches to the temples, 
ft. Calomel. 3 i. 

Opii gr. ii. — ^misce> ft. pil. ii. statimsumend. 

Noon. No vomiting or purging ; ex- 
cessive thirst. Pulse 114, and weak; 
face still flushed. 

R. Extract Coloc3rnth. Comp. 

Calomel, aa 9b8«— misoe, fiant pil. iv. statim 
sumend. 

Habest Eaema Porg. cum. 01. Terebmtii i ii. 

k2 



196 CHOLBRA. 

2 P.M. — Vomited twice, and had three 
' stools, of pale grey colour. Pulse 114, 
weak, and oppressed. He seemed to be 
sinking; and therefore was ordered a 
small quantity of sago, with Madeira 
wine. 

5 P.M. — ^Pulse more free ; face flushed; 
has pain at the navel ; he feels warm 
and better, and the tongue is warm, but 
he is sufiering from great thirst. 

Apply sixteen leeches round the navel, 
R. Pil. Hydrarg. gr. vi. statim. 

Cre^gn of Tiutar drink 4 02s. at a time. 

June 19M. — Vomited once this morn- 
ing, and had two scanty watery stools, of 
grey colour. He is restless and very 
thirsty; face flushed; pulse 106, soft, 
and natural ; tongue warm and moist. 

Apply sixteen leeches to the nucha. 
R. Extract. Colocynth. Comp. 
Pil. Hydrarg. && gr. v. 
Opii gr. ^ — misce^ fiant piL ii. statim sumend. 



CHOLERA. 197 

Ol. Ridnl 

Aquie Cinnamon. lA^i. to be taken at noon. 

3 P.M. — ^Vomited several ihnes after 
taking the pills ; and the oil was quickly 
rejected; he has had two black, fluids 
feculent stools. Is weak, and anxious ; 
and has been tossing about in bed all 
day. 

Ordered to take Pil. Hydrarg. gr. vi. imme- 
(lately. 

A small quantity of sago and wine was 
given an hour after the pill. 

9 P.M.— He feels much better : has 
had two black watery stools. 

Repeat the Blue Pill. 

June 20M— He slept little; has had 
no stool during the night : one scanty 
brown stool this morning: lies on his 
back, in a state of great anxiety ; there 
is slight tension of belly, and some ten- 
derness on pressing over the abdomen ; 
tongue moist, and white. Pulse 108. 



19S CHOLERA. 

R. Extract. Coloc3mth. Comp. 
Pil. ttyAxntg. dOLgr^r, at A«2ir. 
01. Ricini J i. at noon. 

Flwfper'.— He vomited some of the caap- 
tof oil, with bile ; had three black w&terjr 
stools^ and feels better, 

Bs. Pil. Hydrarg. gr. vi. 

Opii gr. ss. in a pHl at 8 f.h. 
Allowed Cireafii of Taitat drink. 

June 21st. — ^He has had no stool or 
Vomitifi^ during the nights 

R. Extract. Coloe3mtli. Comp. 

PiL Hydrarg. iia gr. v. at 6 a#u. 

Vesper. — Has had no stool, and says 
he is well ; tongue warm and moist* 

R. Pil. BLydrarg. gr» v.— hjs- 

June 22d. — No stool ; say & he is well^ 
and hungry. 

R. EKtraci. Colocynih. Comp. 9 ss. 

Pfl. Hjdieaipg. gr. v^^-miscey fiont pil. iii. sta- 
tim somend. 

These pills had no effect until they 



CHOLERA. 199 

• 

were assisted by a purgative enema, and 
then he had four stools. Had a few mild 
purgatives after this, and was discharged 
well on the 1st July. 

Case XXXV. — Edward Enderson, 
JEt. 30, an emaciated man of light com- 
plexion; a sailor of H.C. Frigate Hast^ 
ings; six years in India. Admitted into 
General Hospital 13th February 1826. 
Has been ill for above two months, with 
quotidian intermittent, enlarged spleen, 
and general debility. Bowels free; tongue 
moist. 

Was ordered to be purged daily, with 
compound extract of colocynth ; of which 
five grains only were given at bed-time ; 
and he took two grains of quinine in so- 
lution in two ounces of Water, with six 
drops of aromatic sulphuric acid, daily 
at 6 A.M. and the same dose was repeated 
at noon. 

Feb. 19iA»— There has been no return 



2Q0 CHOLERA. 

of ague, and his appearance ib more 
healthy ; spleen smaller. 

Quinine omitted.-~-Coiiip. Elt, of Colocynth. 
continued. 
/ 

' Feb. 20M.— Was attacked in the night 
with vomiting, purging, and dreadful 
cramps in the muscles of legs, and belly ; 
but made no report of this illness till 
daylight, when he was observed to have 
the sunk ghastly visage, and hollow eye, 
peculiar to Cholera ; the pulse at that 
time was not very low, the limbs and 
tongue not quite cold : but his appear- 
8^nce was exceedingly altered* 

R. Calomel. 9 i. 

Opii gr. iii. — misce^ fiantpil.ii. statim. 
A blister was applied to the scrob. cordis. 
Brandy and hot-water each 1 oz.*— ordered 
to be taken now^ and repeated in an hour. 

The appearance of Cholera subsided 
in the course of the day, and the next 
morning he. was ordered to take 



CHOLERA. 20 1 

Magnetdse 3n. 

Puly. Rhd - . 

Pulv. Jalap, aa 9 i. 

Aqiue Menth. Pip. J iss.— to be repeated in 
{»x hours, if the Gnat dose should . not operate 
foeelj* 

Feb. 22£/.— Purged freely by the first 
dose of medicine. 

He recovered under the use of aperient 
medicine frequently repeated. 

Case XXXVI. — ^Mrs. Brannigan, Mi. 
30,- a small and thin woman ; was seized 
at midnight with purging, vomiting, and 
cramps in the legs ; and sent to General 
Hospital at 6 a.m. on the 23d May, 
1827. The commencement of collapse 
was at that time evinced by extreme 
prostration of strength, sunk eye, cold- 
ness, and a weak pulse at 120 : the 
tongue was cool, moist, and nearly 
clean ; voice feeble and pectoral. She 
had not taken any remedies; 

k3 



302 CHOLSRA. 

R. Calomel. 3 1. 

Opii gr. fi. to be taken in pfflaimniediate^.^ 
Apply a blister to the icrob 



At 8 A.^'^-She had vomited twice, 
but not rejected the pills ; had two stools, 
quite white, like magnesia and water; 
in other respects no change since ad-^ 
mission : she has occasional cramps in 
the legs. 

R. Calomel. B L 

Extract. Colocynth. Comp. 9 sa. 
Opii gr. i. — misce, ft. pU. ii. statnn sumenda^ 
To t^ke 01. Ricini J i. at 11 a.m. 
Some sago with port wine to be given two 
AofirB after tiie caatcnr ofl. 

Vespef.—HtLS had several stools : tber 
pan of the night-chair is nearly full of 
dark-hrown water : surface of the body^ 
as well as the tongue, wdrm. Cramp» 
ceased, and the pulse free* 

R. Kl. Hyctarg. gr. x. 
Cidomel. gr. iv» 
Extract CoIoejrnA* Comp. gr. yu 



- CHOIiERA. 203 

Opii gr. i.^mifice et divide in p3. !▼. 
Two pills to be taken at 6, and two at 9 
o'clock P.M. 

May 24th, 2 a.m. — ^Has had sevei'al 
feculent stools, of brown colour. Extre* 
mities and surface generally Trarm, 
toilgud dry and hot, the ptdse has risen. 

R. Extract. Colocyntb. Comp. 

KI. ttyirtctg. aa gr. v. — rxAsce, fiant pil. 
iL fttatitt liFumendtt. 

These pills had produced several dark* 
grey copious feculent stools before 7 A.M. 
the patient was then suffering from hic- 
cup, but was free from other unfavour^ 
able symptoms; pulse 84 and soft; 
tpngue warm, moist, and little white. 

This patient recovered slowly, and 
required great care ; being twice during 
her convafescence aflPected with dysen- 
teric symptoms; and then she passed 
some blood with her stools. She used 
mild purgatives for many days, and left 
Hospital on the 25th June, to proceed 



^04 CMOLERA. 

in a boat to Chmsurah with her husband; 
being still very weak. 

This woman was nursing a child about 
six months old, when she was seized with 
Cholera : she would not be separated 
from the infant, which remained in the 
bed crawling over its mother when she 
was suffering severely from the cramps. 
While the bad symptoms of Cholera 
existed, no milk was secreted ; but 
during convalescence the flow of milk 
returned, and after an interval of twelve 
days the mother nursed her child again, 
on the 5th June. 

If Cholera were very liable to be con- 
tracted by personal communication, this 
child was exposed to its influence in the 
highest degree, but shewed no sign of 
ailment. 

Cask XXXVIL John Berrigan, Mt. 



CHOLERA^ 205 

19, rather a slight made man, with thin 
face, and red nose : recently arrived in 
Bengal : was admitted into General Hos- 
pital, on the 21st February, 1826, for a 
cough of two weeks duration. He was 
well on the 1st March, and would have 
been discharged next day, but he was at- 
tacked at 4 A. M. 2d March, with watery 
purging, and was twenty times at stool 
before half-past 7 a. M. The eyes were 
then sunk, the countenance was anxious, 
and he TSuflFered from dreadful thirst, had 
a white moist tongue, and the skin was 
moderately warm. He spoke of having 
pain in the belly, but rude pressure over 

the abdomen was borne without copi- 

..... 

plaint. 

R« Opiigr. ii..statim sumend. 

Apply a blister to the Epigastre. 
Allowed brandy J iii. with hot water 3 
yi. — ^to be given in small quantities. 
Orderied a flannel dress. 

Half past 8 A. M. — *The brandy and 



206 



opiun were quickly Tomitedy and he is 
becoming colder and lower. Pulse very 
feeble, pargiag continues. 

R. lliict. opii — Spirit. iBther. Salph. aa 3 88. 
01. CimianMHi. gtt. v. 
Aquae Font | i88.->iiii8ce^to be taken now. 

11a. If. — ^M uch nausea and an^ety, 
with dreadful distress from thirst, con- 
tinue ; but the purging has ceased ; his 
extremities are warm, and there is an 
equal general perspiration over the sur- 
Ikce. 

Be £xtract Colocynth. Cotnp. 
Calomel, aa 3 ss. 

Camphors gr. ii. — ^misce^ fiant pil. iii. 8ta- 
tim 8umend. 

Vesper. — Had no stool since 8 A. m. he 
suffers much from thirst. 

Habeat Enema Purg. cm». Ql. Terebinth.^ ii 

March 3i/. — Had no stool: he is suS&v^ 



CHOLERA. 207 

ing from great anxiety, but his pulse i» 
soft, even, and moderate. 

£nema Purg. cum. 01 Terebinth. 3 ii« 
R. Pttlv. Jalatp. 

Pulv. Rhei. ai 3 i. — Magnesiae. d ii. 
Aquae Menth. Pip. 3 ii- — ^misce^ to be taken 
at 6 A. if. 

March Ath. — ^He has been freely purg- 
ed, the stools are black and feculent ; 
the circulation is free, and all bad symp* 
toms have ceased, 

ItetieBt the purgative as yesterday* 

A slight feverish disposition remained 
after this, which required a repetition of 
mild purgatives almost every day, till he 
was disc^iarged from Hospital on the 
llth April, 1826. 

Case XXXVIII. — Joseph Cocket, 
Mt. 19, a middle-sized lad, of dark com* 
plexion, a sailor of the French Ship Ma- 



208 CHOLBRA. 

gellan^ arrived in the Hooghly twenty days ' 
ago ; went on shore on the morning of 
13th December, 1829, and was soon after 
seized with purging, which continued all 
day ; but he paid no attention to it, and 
took no medicine^ In the course of the 
night he became weaker, and had spasms 
in his legs : finding himself very ill on 
the morning of the 14th, he desired to be 
sent to Hospital, but did not arrive- 
there till a quarter past twelve at noon. 
The stage of collapse was then establish- 
ed; the surface was cold, the fingers 
were shrivelled ; pulse at wrist hardly 
perceptible ; voice feeble, tongue cool, 
purging and vomiting had ceased : he 
was drowsy, and did not appear to suffer 
pain. Torpor and death were evidently 
approaching, but we were unwilling to 
abandon the man while he was breathing ; 
therefore an attempt was made to excite 
action by stimulants. A blister was ap- 
plied to the scrob. cordis, and sinapisms 
to the feet, the limbs were rubbed dili-' 



CHOLBRA. 200 

gently with spirit of turpentine. Twenty 
grains of calomel, with two grains of 
opium, and two drops of croton oil were 
given in pills ; and enemas with oil of 
turpentine were given at 2, and repeated 
at 4 P.M. These remedies had no eflFect. 
The galvanic pile had been in the mean- 
time prepared, and when it was acting 
so strongly as to have a powerful effect 
on several healthy persons, who with my. 
self tried it ; shocks were passed through 
the patient's arms, chest, diaphragm 
and liver; and the galvanism was di- 
rected so as to pass ihrough the situa* 
tion of the great solar plexus of nerves : 
but he shewed not the least symptom of 
feeling its influence. Those persons in 
health, who touched the wires after we 
had ceased to apply them to the patient, 
received severe shocks. 

Calomel. 9 i. with Extract. Colocynth. Comp. 
gr.vi. 

Ol. Croton. gtt. ii. were given in pills at 6 
a*clock. 



210 CHOLERA. 

The patient died at half-past 8 P. U. 
8^ hour& after admission. 

On dissection-^llj^ hours after death, 
we found extreme venous eongestion of 
the brain stnd lungs ; the auricles of the 
heart, and great Veins of the chest and 
abdomen, were exceedingly gorged with 
bloods Liver soft, and of darker colour 
than usual ; gall-bladder somewhat flac- 
cid ; bile of lighter colour than natural ; 
spleen small and soft, adherent to the 
adjacent parts ; the adhesions appa- 
rently not recent. Slight morbid vascu- 
larity of the omentum majus, and of 
exterior of stomach : interior of stomach 
covered with thick paste-like mucus, on 
scraping off which, much general redness 
of the mucous membrane was seen« The 
small intestines distended with flatus, 
and a fluid resembling thin gruel ; they 
were exceedingly vascular, and of florid 
red clour, their lloiog membrane much 
corrugated. There was some morbid vas- 



Ofik>LERA^ 211 

ctilarity of the great intestines ; tiiany of 
the mei^nteric glands enlarged, but not 
inflamed. Much emphysema of the cel- 
lular structure, about that part of the 
duodenum which approaches the right 
kidney, was observed. 



Although mercury is found so useful 
in the treatment of Cholera, especially in 
its febtile form ; it will not prevent the 
accession of the disease, even if taken to 
such an extent as to produce salivation, 
of which iKe two following cases are 
examples; and I have known several 
other instances where persons in a state 
of salivation, have been attacked with 
the worst descriptions of Cholera, with 
collapse. 

Case XXXIX.— James Day, Mt 29, 
sailor of the Ship Norfolk. Had ulcers 
at the orifice of the urethra, for which he 



212 CHOLERA. 

took mercury on board ship, and th^ 
mouth was sore : a looseness of the bow^ 
els became troublesome for two daySi, 
and iherefore he was sent t>n shore, to 
the Hospital, in the evening of the 20th 
March, 1828. There were then no symp* 
toms except those of common diarrhoea, 
but he was very thirsty; the pulse was 
good ; tongue white but moist. He was 
directed to take some castor oil. 

About midnight he began to vomit^ 
and was attacked with cramps in the legs 
and arms. He did not make these 
symptoms known till day-light, when he 
was found in a state of extreme exhaus. 
tion, having been at stool fourteen times, 
and the pan of the night chair was filled 
with a conjee-like fluid. There was 
morbid sensibility at scrobiculus cordis ; 
pulse 96 and soft ; tongue moist, warm, 
and whitei Twenty grains of calomel, 
and two grains of opium were given; 
and a blister was applied to the epigas-^ 



CHOLERA. 213 

ire. Calomel, coloeynth, and blue pill 
with a small quantity of opium were 
afterwards taken. Vomiting and pur- 
ging ceased before 11 a.m, ; but cramps, 
thirst, and anxiety continued, attended 
with increasing coldness, which con- 
tinued till he died at 2 a.m. next morning. 

Ca se XL. William Shannon, Mi. 35, 
an emaciated man, came from England 
in the Ship Herefordshire : and had inter- 
mittent fever for two months during the 
voyage, for the cure of which disease he 
was salivated, and the mouth remained 
sore when the attack of Cholera came on. 
He landed on the 1 6th May 1827. His 
bowels were very costive on the 20th ; and 
he was, without any known cause, taken 
ill with symptoms of Cholera at 5 a.m. 
on the 21st. He was then bled to 3 xiv. 
and took two grains of opium dissolved 
in water. At half past 9 A. m. he was 
sent to Hospital in a state of collapse ; 
and died at a quarter past 3 p.m. 



214 CHOIiERA. 

Cask XLI. John Brown, -^t. 22, a 
sailor of the Ship Moira: a stout man of 
light complexion, arrived from England, 
ten weeks ago ; he was on shore all yes- 
terday, but returned to his ship at 8 
o'clock in the evening, and was taken 
ill at 11 P.M. with vomiting and purging, 
attended with cramps in his feet : for 
which he was bled in the night, and took 
some brandy, with a medicine, the nature 
of which he does not know. As he seem- 
ed to be in a dangerous state, he was 
landed and sent to the General Hospital, 
where he arrived at 3 o'clock p.m. 20th 
February, 1832. He was then suffering 
from great anxiety, and pain in the head, 
loins, and epigastre: the peculiar ex- 
pression of countenance indicative of 
Cholera was present in a very marked 
degree, there was a livid circle round 
the eyes, and his fingers were shrivelled ; 
but the pulse was tolerably free, face 
flushed, and surface warm, although the 
tongue was cool. The pupils were di- 



CHOLSRi^. 215 

lated, and he was thirsty, but not call- 
ing anxiously for drink. He was order- 
ed to be bled immediately, but only ten 
ounces of blood could be got from the 
vein : it appeared black as it flowed ; on 
being- left at rest, a small quantity of 
bloody serum separated ; and the cruot 
was very soft, and black. He was or- 
dered to take 

Calomel. 3 i. in pills^ and a draught of 
Tinct. Opii gtt. xx. 
Aquse Cinnamon. ^ i. 

At 4 P.M. — He is much weaker, and 
his face is more livid, the hands are still 
warm, and he is not suffering from 
spasms; pulse 132, and much more 
feeble : he suffers from increased anxie. 
ty, and at times lies in a torpid state for 
a few minutes. 

Apply a blister to the Epigastre and another 
to the spine. 

R. Liquor. Ammoniae Purse 3 i. 

Aqus Cinnamoni i iiss^-^misce^ to be taken 



216 CHOLERA. 

immediately; nfter which, let him have brandy, 3 
ounces, in hot sago. 

At 5 P.M. — ^There is slight increase of 
warmth, but no other favorable symp- 
tom ; his pulse continues rapid and weak, 
there are cramps in his legs at present 
and he has occasional nausea, but has 
neither vomited, or been purged since 
admission. 

Apply sinapisms to the feet. 
Liquor Ammoniae to be repeated at 5, 6, T, 
and 8 o'clock. 

At 9 P.M. — He is weaker, and colder; 
the voice is feeble, pulse 132 and weak ; 

he has had no vomiting or purging. 

♦ 

Let him have 3 ounces of brandy with hot 
sago. 

Apply a large mustard plaster across the 
lower part of the chest. — The Liquor Ammoniae to 
he repeated every hour till midnight ; afler that, 
every second hour. 

February 2Ut^ at 6 a.m. — He has had 



CHOLERA » 217 

a restless night, with constant distress* 
ing nausea, but he has not actually vo- 
mited, nor has he been purged. The 
voice is stronger : pulse 1 1 4, but very 
weak. His tongue is warm, and he says 
the pain at the epigastre and in the loins 
has ceased. The mustard plasters have 
blistered his feet ; and the blisters which 
were applied yesterday had commenced 
^ to vesicate, when he pulled them off in 
the night. 

R. Extract. Colocynth. Comp. — Pil. Hydrarg. 
aa 3 ss. 

01. Menth. Pip. gtt. ii. to be taken in pills at 
6 A.M. and repeated at 8 and 10 o'clock. 

01 Ricini 3 iss. to be given at 12, and re- 
peated at 2 o'clock. 

At 5 P.M. — He has had no stool, and 
has not vomited ; there is now an uni- 
form warmth of the extremities, the pulse 
is 104 and soft, the tongue moist and 
warm. He is free from pain, and the 
voice is much stronger ; but debility con- 
tinues to such degree that he cannot 



2 IS CHOLERA. 

raise himself in bed without assistance ; 
he has slept for two hours this after- 
noon. A purgative enema was ordered 
at 5 o'clock, and repeated at 7, by which 
a considerable quantity of dark-coloured 
watery fluid, of a feculent smell, was 
brought away ; the lurid colour of the 
face is much decreased. Hot sago with 
three ounces of brandy allowed • 

R. Extract. Colocynth. Comp. 9 ss. 
Pil. Hydrarg. gr. y. 

Olei Meiithae Pip. gtt. li. to be given in three 
pills at 10 o'clock^ and repeated at midnight. 

« 

Feb. 22^.— He slept little ; the pulse 
is 94 and soft, the tongue warm, of 
a lurid red colour, moist, and nearly 
clean; the skin is now nearly of a natu- 
ral temperature, but not so warm as last 
night ; the abdomen is doughy, inelastic, 
and rather full, and he complains of pam 
in the belly. He has not vomited, and 
had no stool during the night. 



CHOLERA^ 219: 

R« Extract* Colocynth, Comp. 

Pil. Rhei. Comp. aa gr. vi. ' 

Olei Menthae Sativae. gtt. ii. to be taken in 
two pills at 7 A.M. and repeated at 9^ and again at 
11 o'clock. 

At Noon. — Pulse 92, the skin warm, 
tongue moist, and rather more loaded ; he 
Jias had three fluid stools of a yellowish 
grey colour ; he feels sleepy and thirsty. 
There is a slight flush in the cheeks, and 
he has made urine for the first time since 
his admission. 

Let two more pills be repeated at 3 o'clock. 
Allowed some hot tea ^d bread. 

At 7 P.M. — Pulse 96 ajid soft ; he had 
two free, fluid stools, of natural colour ; 
he made urine again when at stool. 

R. Tinct. Camphorse Comp. 3 ii. 
Aquae Tepidae ^ iss. 

Sacchari 9 ss,--miscey to be taken at 8 
o'clock. 

Feb. 23fi^.— He had three fluid stools 
in the course of the night, of natural 

L 2 



220 CHOLfiUA* 

colour; pulse 88, soft, and free; tongue 
moist, nearly clean, and still retaining 
some degree of the lurid red colour be- 
fore reported. The belly i& soft, flat, 
and elastic; voice strong, and counte- 
nance cheerful ; he is thirsty, but the ap- 
pearances of Cholera have subsided. The 
feet are very sore from the strong mus- 
tard plasters. 

After this date he required only mild 
purgatives, and regulated diet. On the 
28th February he joined his ^ip, as she 
was about to sail. 

Case XLIL— David Murray, iEt. 21, 
H.M. 26th Foot, a stout and tall man of 
light complexion, two years in India; 
came from Chinsurah on business, and 
walked all day in the sun, in Calcutta. 
Was seized at a quarter before 9 o'clock, 
P.M. 24th Nov. 1830, with violent 
cramps in the extremities, and so much 
pain in the fingers and toes, that hb 



CHOLERA. 221 

roared aloud with agony. A Serjeant of 
his regiment put him into a palankeen 
and brought him directly to Hospital, 
where he arrived just after 9 p.m. suf- 
fering the utmost pain from the spasms ; 
but his circulation was free and surface 
warm ; he had neither vomited nor been 
purged. He was immediately bled to 
lb. iss. and ordered 

Calomel 3 i. 

Extract Coloeynth. Comp. 3.ss. in pills. 

The spasms decreased while the blood 
was flowing, and ceased altogether with- 
in ten minutes after the arm was bound 
up. As the blood cooled, a moderate 
quantity of serum separated; and the 
fiurikce of the cruor was rather more flo- 
rid than usual with venous blood. 

Nov. 25th. — ^He had one stool during 
the night, and feels well^ but weak. 
Diet — tea, bread, and sago« 



222 CHOLERA. 

R. Extract. Colocynth, Comp. 3 ss. 
Pil, Hydrarg. gr. v. in pills. 

These pills purged him freely. 

He was well enough to proceed in a 
boat to his regiment at Chinsurah, on the 
26th November. 

At the time this man was attacked, we 
had many very bad cases- of Cholera in 
the General Hospital ; arid the men of 
his regiment at Chinsurah, about 18 
miles distant, were suffering from a se- 
vere description of Spasmodic Cholera. 
Therefore I am inclined to think that if 
this patient had not been promptly bled, 
he would have had vomiting, purging, 
and other bad symptoms in a short time. 



In many of the foregoing cases, therfe 
was coldness, sinking of vital power, and 
failure of the pulse ; coeval with the ear- 
liest symptoms of the disease ; and under 



CHOLERA. 223 

circumstances in which blood-letting was 
not considered justifiable. We find that 
these patients derived benefit from opium 
and small quantities of stimulants : their 
most distressing sensations of debility, 
and the lowness of the pulse, were often 
relieved by hot sago and wine. In many 
instances an opiate given early ; and a 
dose of castor oil a few hours afterwards ; 
seem all the treatment that is requisite. 

In other patients, a slight and transient 
feverish aflFection, was- followed by col- 
lapse of the most formidable description ; 
in which it was necessary to give a small 
quantity of opium and stimulants, before 
it was safe to employ purgatives and 
apply leeches* The patients who were 
treated early, in the low form of the 
disease ; had in general more prompt 
recoveries, and were less liable to 
relapses, or to febrile affections, on 
returning to their usual food; than 
those who had febrile and inflamma- 



224 cholsra; 

tory symptoms from the commence- 
ment. 

On perusing the accounts we receive 
from home, I observe that the low form 
of Cholera, with early collapse, has occur- 
red in some parts of England. Should 
the disease prevail extensively in Great 
Britain, I think it probable that cases 
will occasionally be met with, which 
commence as diarrhoea, catarrh, or slight 
fever ; and after a few dayis evince a ten- 
dency to Cholera. 



Cholera in Children. 

European children under two years 
of age, do not very often suffer from 
Cholera ; but among those who are at- 
tacked by the disease at that early period 
of life, a large proportion die : which I 
ascribe as much to the early treatment 
employed, as to the malignity of the disr 
ease, for, when called to see children suf- 



. CHOLERA, 225 

fisring from this complaint, I have usually 
found that Cholera had existed for seve* 
rai hours before the relatives were alarm- 
ed by suspicion of the real nature of the 
disease ; and then such powerful doses of 
laudanum were given, that the child has 
been found in a stat^ of stupor ; the cold- 
ness of extremities remaining, and the 
fatal event quickly followed. In chil- 
<iren under two years of age, the disease, 
if left to the course of nature, usually soon 
sinks into the stage of collapse^ with mor- 
tal coldness; and a distinct reaction 
rarely takes place : some morbid heat of 
head and chest usually occur just before 
death, but too transient to afford room 
for hopes of a favorable termination. 
Spasms are not a general attendant on 
the complaint in these young subjects; 
who are quickly oppressed by the venous 
congestion. After the contents of the 
stomach are thrown up, violent efforts to 
vomit usually cease ; occasional nausea, 
and slight ineffectual retching occurring 

l3 



226 CHOLERA, 

now and then ; but unless the patient be 
indulged in much drink, nothing is vomit- 
ed, though the watery purging continues, 
with gradual sinking of the pulse, and in- 
creasing coldness. 

When Cholera in young children super- 
venes on Diarrhoea or Dysentery of seve- 
ral days' duration, the disease is almost 
inevitably fatal. 

When Cholera attacks children imder 
two years of age, the first symptoms of 
the disease are generally attended with 
extreme prostration, and cold perspira- 
tions. In such cases, four drops of 
Cholera Tincture*^ mixed with a little 
sugar in a tea-spoonful of water, will 
very often completely arrest the disease. 



* The Cholera Tincture is composed of 
Tinct. Opii 

Spirit, ^ther. Sulphuric, aa J ss. 
01. Cinnamon, gtt. XV. — ^misce. . 



€HOIiERA. 227 

If the coldness and profuse watery eva- 
cuations from the bowels should conti- 
nue, the dose may be repeated in ah 
hour: after which, if farther stimuli 
Should be requisite, we must make use of 
liquor ammoniae, with infusion of ginger, 
or of capsicum ; and apply mustard plas- 
ters to the pit of the stomach, spine, and 
feet. Should these means fortunately 
resuscitate the patient, much care will be 
requisite to prevent a return of the 
symptoms : mild aperients must be used, 
and great caution in diet observed for 
some days. 

In the treatment of young subjects, 
when they are seen in the febrile stage of 
the disease ; I have usually given to pa- 
tients between two and four years of age, 
four grains of calomel : and if the eva- 
cuations have been profuse, I add fifteen 
-drops of tinctura campboree comp. in a 
tea-spoonful of hot water; and repeal: 
the dose in an hour if the symptoms con- 



228 CHOLERA. 

tinue. Should these means not check 
the disease, a third dose of calomel is 
given in an hour more, with six drops of 
the Cholera Tincture. And if the dis- 
ease still be not arrested, the calomel is 
persisted in every hour ; and the Cholera 
Tincture is given with every second dose. 
As soon as the stomach is tranquillized, 
and will retain food, let a tea-spoonful 
of brandy, or a desert-spoonful of sherry 
wine, be mixed with a coffee-cupful of thin 
arrow-root ; a table-spoonful of this may 
be given once every half-hour, until the 
coldness of surface subsides ; after which 
it is necessary to give a dose of rhubarb 
with two grains of calomel every eight 
hours, and a dose of castor oil in the 
intervals between the doses of rhubarb ; 
so that a mild purgative shall be taken 
every four hours during the day, until a 
moderate purgative effect is produced ; 
smaller doses, at more distant intervals, 
being requisite for some days afterwards^ 
till the secretions are restored to a natu- 



CHOLERA. 229 

ml state. There is usually some obscure 
pyrexia, with much languor for several 
days, in European children who survive 
an attack of Cholera ; and therefore 
the diet should be regulated so as to 
support strength, without exciting fever. 
Where the Cholera symptoms in chil- 
dren are less severe and more protracted, 
while the coldness, and low form of the 
disease remain, there is usually great 
thirst and anxiety. In this case, large 
draughts of cold water have decidedly 
caused a return of the vomiting, and 
hurried on the stage of collapse. The 
least injurious drink, is an infusion of 
mint, with a moderate proportion of car- 
damoms, or a weak infusion of ginger, or 
pepper in water, drank in small quanti- 
ties, and cold. 

During an attack of Cholera, children 
should be wrapped in warm flannel, and 
eneouraged to be quiet in the recumbent 
postisre. In patients between sixandeight 



5230 CHOLERA. 

years of age, the above doses of medicine 
are to be increased one-halif; and may 
be doubled for those more than eight 
years old. 



Cholera in Asiatics, 

When Cholera attacks robust Asiatics^ 
who are living in affluence, they very 
seldom have that form of the disease 
which is at the commencement combined 
with pyrexia and inflammation: and that 
description of the disease which usually 
affects the poorer natives of Bengal,, is 
still more rarely attended with febrile or 
inflammatory symptoms ; they commonly 
suffer from the low form of Cholera with 
sudden coldness and early collapse. Visce- 
ral disorders are seldom found to occur as 
its sequelaB in natives; though I have seve- 
ral times seen a sub-acute description of 
Dysentery ; and more frequently, dyspep- 
tic symptoms and emaciation, occurring 



CHOLERA. ^31 

in native patients who had previously 
suflfered an attack of that disease. 

The Cholera happening to natives of 
this country, marked by early coldness 
and collapse, and occasionally attended 
with severe spasms, is usually a mor^ 
rapid and more fatal disease than we find 
it in Europeans: consequently we do 
not often see Asiatics in a state requirs- 
ing V. S.,. or at that stage of the disease, 
when we might hope by bleeding to re* 
lieve the system from increasing conges^ 
tion. Very few natives of this country 
recover from Cholera, if left without re- 
medies; whereas, if promptly treated, the 
majority of ordinary cases are cured; 
A tea-spoonful of laudanum with a 
spoonful of brandy, or a tea-spoonful of 
laudanum with as much spirit of sal 
volatile, in a wine-glass of water, if given 
at the first moment of attack, very ge- 
nerally arrests the disease instantly. A 
gentleman who had a numerous retinue 



232 CHOI^BRA, 

of servants, used to keep a vial of lauda- 
num, and another of spirits of hartshorn, 
on his dressing table, in charge of a sirdar 
bearer, who being always present in the 
house, had orders to administer a tea- 
Bpoonful out of each vial, mixed with 
a spoonful of water, to any native that 
might be attacked with Cholera. Under ' 
this mode of treatment, no man died for 
many years. Others have been nearly 
as fortunate in checking the early stage 
of Cholera, by keeping a bottle of Tinc- 
ture of Rhubarb in readiness, and giving 
a table-spoonful to any native imme- 
diately he was attacked with Cholera. If 
stimuli are requisite after the second 
dose of Laudanum, Liquor Ammoniae is 
the best. I have found it convenient to 
keep the. Cholera Tincture^ mentioned at 
page 226, always in readiness : a desert- 
spoonfiil, given in a wine-glass of water 
to an adult, I think generally answers 
better than any of the above remedies, if 
«,en equau/eari, in the dise^. B, 



CHOLERA. 233 

whichever of these modes the first ap- 
proach of an attack of Cholera in a 
native is arrested, it is usually proper to 
order a cup of hot sago, within an hour 
after the medicine ; and if the patient be 
a weak person, and any degree of cold* 
ness remain, a spoonful of brandy ought 
to be added to the sago. If the first dose 
of either of the above medicines be 
rejected by the stomach, or fail to have 
the desired effect, it should be repeated 
in one hour; after which, if the symp- 
toms continue, six grains of blue pill, with 
one grain of opium, and two of asafoetida 
in a pill, are to be given an hour after 
the second dose above ordered, and re- 
peated every second hour while vomiting 
and purging continue. More sago may 
be given after a few hours ; and provide 
ed the disease be arrested, we should 
allow the patient to remain quiet wrap* 
ped in a blanket for eight or ten hours ; 
and then give him a dose of castor oil. In 
a few cases, where febrile symptoms re* 



234 CHOLERA.. 

tnain after a Cholera attack in natives, 
leeches are requisite to remove local 
congestions and inflammations ; and four 
grains of blue pill witheightgrains of com- 
pound extract of colocynth, may be given 
daily in the morning; followed in six 
hours by an ounce of castor oil, if the 
patient be not purged by the pills. In 
native Cholera patients, having symp- 
toms of Spleen Disease, mercurial pre- 
parations should be omitted. Asafoetida 
combined with opium often has a remark- 
ably good effect on natives who are slowly 
becoming cold, with Cholera symptoms ; 
the oriental mode of administering it, is 
to make a soft pill of two grains of opium 
with as much asafoetida, which is chew- 
ed and swallowed slowly with the saliva. , 
I have ordered this prescription, with the 
addition of six grains of blue pill, and 
two drops of Ol. Menth. Pip. directing 
the medicine to be chewed and swallowed. 
It has been the means of curing many 
natives who had become cold, and had a 



CHOLERA. • 235 

rapid feeble pulse that was hardly per* 
ceptible. The warmth was gradually 
and slowly restored, and circulation re* 
covered its natural strength, after the use 
of this medicine : nothing being required 
but a few moderate doses of castor oil ; 
and attention to regulate the food used 
by the patient for some days. 



There is such variety in the symptoms 
and course of Cholera in different pa-i 
tients, that I am induced to state two cases 
of Europeans, and one of an Asiatic, in 
which the secretions were carefully ana- 
lysed ; so that there may be no doubt of 
the exact nature and stage of the disease, 
corresponding with the fluids examined : 
and I may observe, that the general ac- 
count of Chemical Analysis stated at page 
23 to 34 is the result of experiments^ 
made in every stage of the disease. The 
conclusions deducible from all my inves- 



236 ^ CHOLERA. 

ligations relative to tliis part of the sub* 
ject, are adverse to the opinions of those 
authors who say that the sub-albid stools, 
resembling barley-water, are pure serum, 
as some state ; or serous evacuations, as 
others have asserted. This, like every 
truth connected with the pathology of 
acute diseases, may be deemed impor- 
tant ; for it will influence our opinions 
regarding the condition of a patient ; and 
our practice must of course be more or less 
modified by such opinions. Moreover, 
attention to the nature of those secretions 
may be of use in fixing the identity of the 
disease now treated of, and establishing 
its a£Binity with the Cholera of remote 
countries; or with the varieties of dis- 
ease which may hereafter appear in India. 
With this view, I have been willing to 
state particularly the nature of a few of 
the cases from which the fluids examined 
have been taken. 

Case XLIII. — ^Pierre Vinceau, Mt. 



C HOLERA. 237 

1 9, a sailor of the French ship Cygne^ 
sent to Hospital in the most alarming 
state of disease : no written account of 
his case was received with him. Admitted 
4th December, 1830, at 10 a.m. A slight 
made lad, of dark complexion, six weeks 
arrived in Bengal; states that he was 
taken ill at 6 p.m. yesterday, with a 
sensation of weakness, and pain at the 
heart : vomiting and purging took place 
soon after, and he had cramps in his legs 
during the night. He has been very 
often to stool, but only vomited four 
times in the night, the last time at 10 
P.M. Has been thirsty, and drank much 
water. His voice is good and strong, 
and there is very little anxiety at present. 
Pulse 120 and feeble; extremities cool 
and perspiring, but not cold; tongue 
cool, moist, and nearly clean ; the eyes 
are not sunk ; he is tranquil, and no.t 
now calling for drink. Had one grey 
fluid stool, in quantity about 10 oz. soon 
after admission. 



238 CHOLERA, 

When the bulb of the thermometer 
was placed under his tongue, the mercury 
stood at 91, and temperature of the ex- 
tremities was ascertained to be 82. The 
atmosphere being at this time at 76 de- 
grees of Fahrenheit, 

Spirit of turpentine was rubbed to the 
extremities constantly. He was made 
to swallow half a drachm of Cajeputi Oil, 
in half an ounce of cinnamon-water ; and 
the dose was repeated in half an hour. 
No effect being produced by the two 
first doses, one drachm of the oil was 
given at 1 1 o'clock, and repeated every 
hour till 3, making in all, six drachms of 
the Cajeputi Oil. 

Half past 3 o'clock. — ^The patient has 
been frequently visited, during the inter- 
val since 10 o'clock : the Cajeputi Oil 
has had no effect; he appears rather 
worse, and is very slowly sinking into a 
state of torpor : there has been no vo- 



CHOLKRA, 239 

miting, but he has had three more conjee 
stools, each in quantity about 8 oz. 
Hot sago 3 oz. brandy 1 oz. directed to 
be taken just after the last dose of Caje- 
puti Oil. 

R. Calomel* B i. — Opii gr. J. 

Extract. Colocytith. Comp. — Asafcetidse aa 
gr. V. 

01. Menth. Pip. gtt. ii. to be taken in three 
pills ; and repeated every hour* 
R, Spirit. Ammoniae Aromat. 

Tinct Cardamom. Comp. aa 3 i. 
Aq. Cinnamon. J iss. misce^ — ^to be drank 
after each dose of pills. 

SLv o'clock. — He continues slowly sink- 
ing. The same pills and draft as order- 
ed at half past 3 o'clock, are to be given 
every hour till six doses are taken. Hot 
sago and 1^ oz. of brandy at half past 9 
o'clock. Castor Oil 5 i. at 10. 

Dec. 5th. — No stools or vomiting 
during the night ; the extremities and 
tongue are cold, but the forehead, neck, 



240 CHOLERA* 

and chest, are hot ; the face is livid ; 
pulse at the wrist is barely perceptible : 
he is restless, and asking for drink ; 
respiration hurried and feeble ; voice 
weajt and pectoral. Large sinapisms 
were applied to the belly, also to both 
feet. Ol. Ricini 3 i. was given every 
hour, and fifteen minutes after the oil, 
he was ordered an Enema of Ammoniae 
Carb. 3 i. in three pints of hot water, to 
be given with the pump. He derived no 
benefit from the remedies, and died at 
1 1 o'clock A.M. 

Dissection at 4 p.m. ; five hours after 
death. Much venous congestion of the 
brain. Both lungs universally adherent, 
but not bearing marks of the adhesions 
being recent ; there were a few small 
dark-grey, tubercles in the lungs. All the 
cavities of the heart were gorged with 
coagulated blood ; the anterior portions 
of the coagula white. The liver was 
rather large, its surface mottled; its 



CHOLERA. 241 

structure soft, and bleeding freely when 
cut into. 

The omentum and mesentery were in 
a state of high morbid vascularity ; also 
that part of the peritoneum placed 
across the bodies of the vertebrse : glands 
of mesentery and mesocolon enlarged. 

Peritoneal surface of stomach, and in- 
testines, rather more coloured with pink, 
than in the healthy state. 

The mucous membrane of the stomach 
was exceedingly vascular ; the coats of 
the small intestines slightly thickened : 
there was much pale brown fluid in the 
stomach ; and some fluid in the upper 
third of the small intestines, which was 
tinged deeply with orange-coloured bile ; 
the lower portion of the small intestines 
contained a pale-grey fluid. The large 
intestines contained much dark-brown 

M 



ii4t2 CHOLERA. 

watery fluid. No other morbid appear^ 
ance noticed. 

It may be sufficient to state the result 
of the analysis of the third conjeC'^tool 
voided by this man after his admission 
into the Hospital. That fluid was left 
to stand for two hours, and a quantity of 
grey paste-like mucus had then sub- 
sided ; the following was the result of 
examination. 

1. The mucus which had subsided to the bottom 
of the test tubes was found partially soluble in cold 
water^ affording an opalescent turbid fluid. 

2. Another portion of the sediment^ measuring 
3 ss. and of the consistence of thick mucilage ; was 
entirely soluble in a mixture of 3 x. of Liquor Am- 
mpnioe^ with- the same quantity of distilled water. 

3. Another portion of the same sort of mucuS;i 
measuring 3 ii. was heated in a small evaporating 
dish over a spirit lamp ; and during the process an 
odour of putrid flesh wa^ evolved. It dried into a 
tbin.fijm^ which became charred and black, with« 
out burning in a flame. 



cholera; 24S 

' The watery fliiid was next examined. 

r - . * ^ ^ 

/I 

4. It had a slight effect in reddening litmus p^per.; 
the colour of which was restored by dipping the 
the paper into a mii^ture of four drops of liquor 
Ammonisej, and half an ounce of water. 

5. Heated slowly over sand^ to 200 de^ees of 
Fahrenheit, it did not coagulate. When the hedt 
was raised to the boiling pointy a feMr small grey 
flocculi formed. 

. 6. The addition of a solution of oxymuriate of 
mercury^ produced a slight turbid appearance, and 
at the end of 12 hours, a minute precipitate had 
formed, which was estimated at ^ of the quantity 
of fluid submitted to this experiment: the fluid at 
the upper part of the tube having a slight opalescent 
appearance. 

7* Solution of subacetate of lead, instantly caused 
a dense curdled appearance, which quickly pervaded 
the whole tube, and in a short time began to sub-* 
side 5 at the end of 12 hours it had settled doVirn»^ 
so as to occupy -^ the space of the tube that had 
contained the fluid exai^ined. 

* 

\ m 

8* The addition of alcohol ^to another portion of 
the fluidr produced no effect. 

m2 



244 CHOLERA. 

9. The addition of infusion of galls to another 
portion of the fluid caused a slight turbidness^ and 
after some time a very few minute flocculi sub* 
sided. 

The examination of the fourth conjee- 
stool voided by this patient afforded simi- 
lar results. 

Case XLIV. — Torrens, Mt. 29, a 
muscular man, of middle size and light 
complexion ; a sailor of the ship Mount 
Vernon; arrived from sea about the 
middle of October, 1831; and after re- 
maining a week on board, he landed in 
the afternoon of the 21st, and drank 
some spirits in the bazar, but says he 
was not drunk. Late in the evening he 
was wet by a shower of rain ; and failing 
to get on board, he slept in a shed near 
the bank of Ihe river. About midnight 
he was seized with cramps, followed by 
vomiting and purging; at 9 o'clock a.m. 
he succeeded in getting on board, i^nd 
the Captain gave him 60 drops of lau- 



CHOLERA. 245 

<laiium in a glass of brandy ; after which, 
the vomiting and purging ceased : but 
he remained so much distressed by anx- 
iety and feeling of debility, that it was 
considered best to send him to the Hospi- 
tal, where be arrived at 1 p.m. 22d Oct. 
The stage of collapse was then com- 
mencing : his face was pale ; he was co- 
vered with a profuse perspiration, and 
suffering from much anxiety ; the tongue 
white and clammy ; pulse tolerably free ; 
the belly tense and tumid. A vein was 
opened, and when 3 x. of blood had 
flowed, the pulse sunk so rapidly that it 
%vas not deemed safe to take more. 
Twenty grains of calomel with two 
grains of opium were given. Within ati 
hour the pulse rose, and the orifice of 
the vein being opened, six ounces more 
blood were allowed to flow, by which the 
pulse was rapidly and permanently sunk. 
A large sinapism was now applied over 
his belly, and spirit of turpentine dili- 
gently rubbed to the extremities* The 



246 .GHOLSRAi. 

,t^ ouiiees of blood fir^t drawn^ txwgip- 
iated ; and a stnall quantity of b}oody 
serum separated, M^hich e^n exposure to 
he^t of I6Q^fortiied a firm coagialitoL 
The blood laist draM^n congulated^ . but no 
serum wa^ separated : the cruor erf the 
Hood in both mips was remarkably dafk- 
coloured^ . , 

Calomel, with eqlocynth,, jasafcetida^ 
and oil of cinnamon, were . repeatedly 
administered, and stimulants^ used: and 
he took a dose of spirit of turpentine and 
Castor oil, each one ounce ; but no medii^ 
.cine had any effect; he* gradually ssmk 
into a state of torpor, pulse at the wrist 
ceased, and the fingers became shrivelledi 
He died at 3 A.M. on the 23d October^ 
fourteen hours after admission, into Hns** 
pital: during: which period he had four 
^anty fluid stools of a brown colour, and 
vomited several times. 

. Z)weciio;f,r— Twelve hours after death. 



cnroLEKA. 247 

Muscles rigid; lungs' gorged witii 
blood, especially at the depebding paris{ 
and there was a small quantity of rnucu^ 
ill the trachea alid bronchial tubes: Therd 
i;rere a few small ecchymosed specks oa 
the right side of the heart. Some morbid 
vascularity of the omentum and mesen^ 
tery was observed, and the. glands of th^ 
knesentery and mesocolon were enlarg* 
ed. The stomach was pale externally; 
and its coats much thickened ; its mucous 
membrane corrugated, and covered with 
a large quantity of thick tenacious mu^ 
cus : when that was scraped off, several 
vascular patches of deep-red colour were 
seen. The pills, in solution, and some 
turpentine with castor oil, which had 
been taken several hours before deaths 
remaibed in the stomach. 

The coats of the small intestines were 
much thickened ; at no part could they 
be deemed paler than natural^ but several 
portions for the extent of a foot in 



248 CHOLERA. 

length, had the minute vessels injected 
with red Wood, in a very extreme de- 
gree. The small intestines contained 
much watery fluid ; in some parts this 
was tinged with yellowish bile, in other 
parts of a pale-grey colour, mixed with 
many large masses of white mucus. The 
coats of the colon presented no morbid 
appearance, and this intestine contained 
piUch fluid of dark-brown colour. The 
liver was large, and its texture soft ; the 
colouir was natural, with the exception 
of a slight mottled appearance, from a 
few small pale spots on the surface of 
the left lobe* Gall-bladder, adherent to 
the adjacent parts ; it was much enlarg- 
ed, round, and distended with very fluid 
bile, of a natural colour. There was a 
great degree of venous congestion of 
blood in the brain, and the large veins 
along the spine were gorged with black- 
coloured blood. Some serous effusion 
was observed between the tunica arach- 
noidea and pia mater : there were 3 iiss* 



CHOLERA. 249 

of serum in each lateral ventricle; and 
3 iss. below the tentorium. 

A portion of the fluid vomited^ (and on the top of 
which some castor oil floated^) was filtered; it 
was transparent, with a slight tinge of straw-colour : 
when examined^ the following appearances were 
observed: 

1. Litmus paper was quickly changed to a pale* 
red colour. 

2. Solution of oxymuriate of mercury produced 
a slight turbid white appearance^ but no preci- 
jpitate formed. 

3. Another portion of this fluid, exposed to heat^ 
which was gradually increased up to 212^^ assumed 
a slight smoky colour ; and at the end of twelve 
hours, a few minute grey flocculi were observed 
floating in the fluid. 

4. Solution of subacetate of lead, dropped into a 
test-tube containing some of the fluid, quickly pro- 
duced a dense curdled appearance, which at first 
seemed to consist of all the fluid ; but a precipitate 
soon subsided, and in twelve hours occupied a quar- 
ter of the tube which had been filled with the fluid 
tested. This precipitate was a dense pale-yellow 
mass, not easily mixed with the fluid on shaking the 

m3 



250 CHOLERA. 

tube. The liquid which floated above the predpi* 
tate was nearly transparent, with a slight bluish 
tinge; a few small white flocculi adhered to the 
inside of.the test-tube.' ' 

. 5. On addition of the infusion of gaUs> the fluid 
became turbid^ and a pale lead-colomied precipitate 
formed, which subsided in twelve hour^ j^ t^s to 
occupy ^^ of the space in the tube, which had been 
fflle4 with the fluid tested* The precipitate 'was 
light, and easily difiiised through the flcdd by 
shaking the tube. 

The most fluid of the stools, voided whfle he wag 
in Hospital, was filtered through paper ; and then 
it had the colour of weak coffee, of a peculiar foetid 
odour, not like faeces. The filtered fluid was di-* 
luted with equal quantity of distilled water, for the 
purpose of decreasing the colour, that the effects of 
re-agents might be better observed : and when tried 
with various tests^ the following effects were ob- 
served: 

I*. 

6. Litmus paper was slowly and slightly diai^^ 
to a reddish colour. 

. 7» A portion of the diluted fluid, exposed to heat 
gradually raised to 212^,. became in a slight degree 
^lore transparent ; it did not coagulate, but a few 



CHOLERA. 251 

small black flocculi were seen floating in the fluid 
when it was cold. 

8. When solution of oxymuriate of mercury- 
was added to another portion of the diluted fluidi 
a dark chocolate-coloured precipitate slowly formed, 
and in twelve hours subsided > so as to occupy -^ of 
the space of the tube that had been filled with the 
fluid examined. The supernatant liquor was of a 
pale tea-colour. The precipitate was dense^ and 
not easily raised or difiused through the fluid by 
slight agitation. 

9. The addition of a solution of subacetate of lead 
to another portion produced an immediate dense cur- 
dled precipitate, that quickly fell to the bottom of 
the tube; and at the end of twelve hours it occupied 
•^th of the space in the tube that had been filled 
with the fluid : the supernatant liquor was nearly 
transparent ; a few pale-grey flocculi adhered to the 
sides of the tube. 

10. In another portion of the diluted fluids when 
treated with infusion of galls ; a precipitate slowly 
formed^ of a pale-brown colour, which in twelve 
hours was found to occupy ^th of the space of the 
tube that had been filled with the fluid examined ; it 
appeared like a very light mucilage, and was easily 
again diflused through the fluid, on slightly shaking 
the tube. 



252 CHOLERA. 

Case XLV, — A Mahommedan Bur- 
kandauze, named Shaik Sonawalla, aged 
35 years, employed at the Calcutta 
Great Jail ; was taken ill with Cholera 
about 1 A.M. on the 1st December, 1831. 
He made no application for medical aid, 
and was watched in the Guard-room of 
the Jail, by his comrades, who kept him 
covered with blankets, and champooed the 
limbs when the cramps were severe. My 
advice was notrequested until4p.M.,when 
the friends thought he was about to die : 
they asserted that he had been vomiting 
very often ; but not purged much until 
mid-day ; at which time cramps in the 
legs came on, and the purging and 
coldness were so much augmented as to 
excite alarm. I found him cold^ his 
countenance sunk and ghastly ; eyes 
blood-shot; the fingers slightly shri- 
velled ; voice weak ; pulse 138 and very 
feeble ; tongue moist, and clean ; he was 
anxious, and the respiration hurried; 
he eagerly requested water to drink. 



CHOLERA. 253 

His friends asserted, that he had not 
swallowed any thing since noon, and had 
taken only a few spoonsful of water dur- 
ing the early part of the day. A large 
panftil of clear watery fluid had been 
voided by stool: it was hardly more 
coloured than piure water; some uncooked 
rice, very little swollen, was observed 
at the bottom of this pan. The patient, 
on being particularly questioned, ac- 
knowledged that he had eaten raw rice 
at a very late hour on the previous even- 
ing. The fluid vomited was slimy, and 
not quite so clear as the stools. 

He was made to take 3 i. of Lauda- 
num, with as much Spirit. JEther. Sul- 
phuric, and four drops of Oil of Cinna- 
mon, in 3 iss. of water ; which quickly 
alleviated all the more distressing symp- 
toms ; and he was neither vomited nor 
purged afterwards. 

At 6 P.M. — He was free from cramps : 



254 CHOLERA 

th^ pulse 118; there was slight return of 
warmth of surface; tongue clean and 
moist ; he complained much of thirst. 
Some thin hot sago with i iiss. of bran- 
dy was now given, after which he 
slept, 

Dec. 2d. — Has had neither vomiting 
or purging, but is anxious, weak, and 
thirsty ; eyes blood-shot ; extremities 
warm ; pulse 92, soft, and weak ; tongue 
nearly clean and dry, with little white 
iappearance in centre. He was ordered 
3 is. of castor oil with cinnamon water, 
which purged him four times in the course 
of the day, and he was persuaded to take a 
small quantity of sago, without brandy. 
The stools were copious and of dark-grey 
colour. He now earnestly entreated 
that his friends should be allowed to 
take him home to his village, .which was 
near. This request was complied with, 
and he remained at home nearly a month; 
but took no medicines except two doses 



gHOLERA. 255 

of castor oil. He recovered, and is ndw 
employed on the Jail duties. 

The slimy fluid vomited^ was strained through 
muslin ; and then had a very slight turbid appear- 
ance. 

1* It quickly reddened litmus paper. 

2. A portion was gradually heated to 212 de-. 
grees of Fahrenheit^ but no part of it coagulated. 

S. Another portion tested with solution of oxy- 
muriate of mercury ; indicated no change^ except a- 
yery minute milky cloud> which was dissipated on 
shaking the test tube. 

4. Transparent solution of subacetate of lead^ 
dropped into another portion of the fluids' caused an 
Immediate white curdled appearance ; which slowly 
subsided to the bottom of the tube, lei^ving the su- 
pernatant liquor transparent, with a slight bluish 
tinge. 

The clear watery fluid of the stools was 
poured ofF from the small quantity of 
rice, and examined without straining. 

5. Litmus paper was changed to a red colour 
wh«i wet with this fluid. 



256 CHOLERA. 

6. A portion of the fluid was exposed to heat, 
gradually increased to 212^; it neither coagulated, 
nor did any precipitate form. 

, 7* Another portion of the fluid was tested with 
solution of oxymuriate of mercury ; which slowly 
produced a slight turbid appearance, and in twelve 
hours a minute mucilaginous deposit took place at 
the bottom of the test tube : the fluid above being 
opalescent* 

8. Solution of subacetate of lead^ dropped into 
another portion of fluids in a tube ; produced an 
immediate curdled appearance^ which soon subsided 
in a dense white mass^ and at the end of twelve 
hours was found to occupy -^ of the tube that had 
contained the fluid tested; the liquid above was 
quite dear. 

9. Another portion of the fluid was tried with 
pure alcohol; which produced no turbidness^ nor 
precipitate. 

' 10. Infusion of galls was added to another por- 
tion of the fluid in a tube; which slowly produced 
a slight mucilaginous precipitate^ of a pale-fawn 
colour, which was easily diffused through the li* 
quid, when the tube was shaken. 

To avoid the probability of erroneous 



CHOLKRA. 257 

conclusions, I have tried similar tests on 
the various kinds of food and drink allowed 
to Cholera patients : so as not to mistake 
the effects of the tests on any of those 
articles, for their effects on the secre- 
tions of the stomach and intestines. 

The Cholera stools, and the matter 
vomited, not coagulating on the appli* 
cation of heat, or on the addition of so- 
lution of oxymuriate of mercury ; and 
containing no uncombined soda; shew 
us that they do not consist of the serum 
of the blood, and do not contain any ap- 
preciable quantity of albumen : while the 
indications, when we add the solution of 
subacetate of lead, give sufficient reason 
to conclude that the sub-albid evacua- 
tions in Cholera, consist chiefly of mu- 
cus, and a peculiar morbid secretion. I 
am not aware of the grounds on which 
Dr. Bostock has stated that animal mu- 
cus is merely a modification of albu* 



258 <3HOL£RA. 

men* ; though I am ready to place the 
highest confidence in his opinions. 

Facts relative to Con^ajsion in 

Cholera. 

It is an object of much imj)ortance to 
ascertain, if possible, whether Cholera 
be a contagious disease, and liable to be 
communicated generally to those in 
health, by means of a virus generated 
about the persons of the sick : and con* 
veyed either indirectly, by means of 
clothes or goods ; or received directly, by 
personal contract or near approach td 
patients: whereby the disease is pro4 
duced, independent of other exciting 
causes. If it should appear, that Cho- 
lera is generally propagated by means of 



* ^^ Animal mucus appears to be nearly related 
to albumen^ and indeed the constituent upon which 
its characteristic properties principally depends^ 
would seem to b^ a itiere modification of this sub- 
stance." — Bo8toc^*8 Physiology, vol 1 , p. 48. 



CHOLERA; 2^9 

sottie lioxibw «n0«natit>n» from tiie p»-[ 
sons of the sick ; the strict est qtiarantme 
te^ulations would of course be advisable^ 
0n tlie contrary, should we obiserve ^^t 
the disease is neither generally, nor even 
frequently, found to affect tliose who are 
most exposed to personal; communiea? 
tion with the sick, under such circum* 
stances, that if contagion existed, we 
might reasonably expect it would be 
present in its most concentrated a:nd 
active forms : we would then doubtless 
abandon all idea of retarding the pro 
gress of Cholera, by interdicting direct 
intercourse with the sick, or with those 
who may be exposed to any emanations 
from the bodies of persons suffering 
Under that disease. . 

I will now proceed to state such facts 
as appear conclusive with respect to the 
Cholera of India; shewing the reisults 
of unrestricted communication with the 
sick : and if the disease be neither gene. 



260 CHOLERA. 

rally, nor frequently, received, after the 
most extreme exposure; few persons 
will deem the danger great, from slight 
and transient intercourse with the sick. 
If the disease ever possess contagious 
properties, assuredly there could be 
no difficulty in pointing out the particu« 
lar instances of contagion, at the time 
that they occur. 

The persons most exposed to contract 
Cholera in the General Hospital at Cal- 
cutta, (if the disease were contagious,) 
are those having charge of the bedding 
and clothing, and those employed in 
personal attendance on the patients. 
The man who has charge of the Hospital 
clothing, and his assistant, both attend 
in the wards every morning, changing 
the bedding of one ward each day, on 
ordinary occasions. But when Cholera 
exists, these people are obliged, in the 
majority of cases, to change some of the 
bedding of the patients having that dis* 



CHOLERA. 261 

ease daily, or oftener when soiled ; for 
which, purpose they come to the bedside, 
taking away with them the dirty-bedding, 
which is given to the head-washerman. 
The clothes-keeper, Shaik Selim, at 
present employed at this Hospital, has 
been on that duty for two and a half 
years ; his predecessor Dhowall filled 
the same office for twenty-three years, 
and died at his own house, of old age 
and debility ; having been pensioned for 
long service. The head washerman 
Gawhee, at present employed here, has 
been on this duty about one year and a 
half ; his predecessor Hassye, held that . 
office for two ye^rs, and died of chronic 
disease of the bladder, after an illness of 
near four months. Before this man, 
Beechuck was washerman for twenty-one 
years ; he died of chronic induration of 
the liver, and pulmonary disease. Not 
one of the subordinate washermen or 
people employed about the clothing and 
bedding stores has ever had Cholera^ 



262 CHOLERA; 

The native dressers have daily the 
,il)ost unreserved eommunication with 
Xhe sick, changing the applications over 
ieech-bites, and the bandages ' to the 
itrms of such as are bled; dressing blis- 
ters, and applying sinapisms: not one 
of these men has ever suffered from the 
disease. Buctourie, the heiEid :native 
,dresser, who instructs the subordinates 
and attends with them alt^nately, while 
at their duty, has been constantly em- 
ployed at the Hospital for twenty-sis 
tyears. He is a clever man, of good 
character, and asserts that he has never 
kuown one of the Hospital servants to 
be attacked with the disease. 

. The sweepers who clean and change 
the close-stools, as well as the pans in 
which the matter vomited is received ; 
and who wash those patients who are 
helpless ; have never been known to suf- 
fer from Cholera. It may be supposed- 
that the occupations of the sweepers, are 



CHOLERA. 263 

usually such as might be expected to 
blunt their susceptibility to disease, or 
to the effects of any ordinary exposure ; 
but this will not be urged respecting the 
Hindoo Coolies ; who are emplpyed in 
ordinary attendance on the sick, and are 
.obliged to be much in contact with all 
bad cases of Cholera, to keep the blank- 
ets from being thrown off, and the meii 
from falling out of bed^ when in the 
worst stages of the disease, and suffering 
much from jactitation and restlessness. 
These coolies are also employed to rub 
and champoo the extremities of the 
Cholera patients; and often cannot avoid 
inhaling the breath, as well as the exha- 
lations from the bodies of patients, in 
the most deplorable stages of the disease. 
Not one of these men has ever suffered 
an attack of Cholera. The young stu- 
dents, who are under a course of medical 
instruction, at the H. C. School for Na- 
tive Doctors ; are usually in attendance 
and assisting at the Hospital when Cho- 



264 CHOLERA. 

lera is prevailing in a severe form, and 
when great numbers of patients are ad- 
mitted with that disease, In March and 
April, 1827, when the Hospital was unu- 
sually crowded with Cholera cases ; and 
all the attendants much distressed and ex- 
hausted by the severe duty : a number of 
the young students from the school, were 
brought to the Hospital, and placed in 
attendance over the worst cases ; being 
relieved regularly day and night. These 
young Asiatics performed their duties 
with great diligence, assiduity, and hu-> 
manity, for many days and nights ; and 
none of them suffered by this constant 
exposure to whatever may be contagious 
in the emanations from Cholera patients ; 
as well as frequent contact of their per- 
sons. I publish these statements, after 
having made the most careftJ observa- 
tions on this subject, when the disease 
has been prevailing, during my residence 
at the Hospital : and after the most dili. 
gent inquiry relative to the same points 



CHOLERA. 265 

during the last fourteen years. A reipark- 
able instance of exposure, with impunity, 
to any morbific causes arising from the 
person, during Cholera, is recorded at 
page 204 of this work. 

By Mr. Henderson's account of the 
disease which appeared on board the, 
H. C. ship Berwickshire^ iii Bombay 
Harbour, in June 1830, it appears that 
ninety-four men were taken ill of Cholera 
within a few days ; of whom thirty-eight 
died. A large proportion of the sick was 
landed, and treated at the Bombay Euro- 
pean Hospital, and sixteen of the deaths 
occurred in that Hospital, where there 
were at the time more than one hundred 
patients and attendants, not one of whom 
contracted the disease. 

The History of CHolera in India pre- 
sents us with a vast number of instances, 
where either a body of healthy troops 
has joined and encamped along with 

N 



266 CHOLERA. 

those among whom the Cholera was exist- 
ing in the most violent and fatal form; 
or where a detachment in which the 
disease was raging, has joined a healthy 
encampment: and the disease has not 
heen, in either case, communicated to 
those in a healthy state. A body of 
Holkar's Reformed Cavalry, 500 strong, 
were posted at Mahidpore, adjoining to 
the camp of above 2,000 Bengal troops 
and followers, among whom the epidemic 
was prevailing ; and the Cavalry did not 
suffer from the disease, although a 
Cholera patient from the Bengal division 
was brought to their camp, and went 
through every stage of the disease among 
them. In like manner, Casement's Regi- 
ment of Irregular Horse joined the 
Hansi division of the Army, and remain- 
ed with that division without contracting 
the disease, at the time when the Epi- 
demic Cholera was at its height. On the 
11th May, 1818, a company of Bengal 
troops, ninety in number, encamped at an 



CHOLERA. 267 

unhealthy spot on the bank of a small 
lake, sheltered by a few trees, and sur- 
rounded by ^ low woody hills. The de- 
tachment arrived at this place all in per- 
fect health; Cholera commenced at mid- 
night, and before sunrise next morning, 
twenty men were ill of that disease : they 
were removed to the Saugor camp, in 
carts and doolies, in the course of the 
day ; but before arrival there, five men 
had died, and two were moribund. By 
the end of the week, every man of this 
detachment had gone to Hospital with 
Cholera, or with a purging of some 
sort, resembling modifications of that 
disease : so that there could be no doubt 
of the malignity of the malady from 
Iwrhich they were suffering. The men of 
this detachment had unrestricted inter- 
course with the troops in camp : not one 
individual of whom was attacked with 
Cholera. For these facts, I refer to the 
Bengal Report on Cholera, p. 133, 134, 
and 137. More than a hundred such 

n2 



268 CHOLERA. 

i^stances may easily be collected, by any 
one who will take the trouble to make 
critical inquiries respecting the history of 
Choleraforthelastfifteenyeairs. The facts 
Above cited are sufficient to prove that the 
Cholera in India, when existing in its 
most aggravated form, is not a conta- 
gious disease; and that there is no virus 
generated in or about the sick, by means 
of which the disease may be communi- 
cated to persons in health. The facts 
which prevent our acknowledging that 
the Cholera of Bengal is contagious, 
are numerous, well authenticated, and 
the details are precise. 

It appears, that a body of troops join- 
ing a camp at an unhealthy station, after 
long marches, is very liable to suffer 
from Cholera ; but if a camp in which 
Cholera exists, should move to a healthy 
station, and still numbers of their men 
continue to fall ill of the disease, in con- 
sequence of their past exposure ; troops 



CHOLBRA. 269 

^oming them after their removal to the 
healthy camp, do not suffer from Cho- 
lera. It has often happened, that this 
disease has raged among troops encamp- 
ed on the low banks of a river: without 
any evidence of Cholera having travelled 
to them, or having been propagated from 
them to others at a short distance, who 
communicated freely with those suffer- 
ing from the disease. Epidemic inva- 
sions of Cholera, arrive at their acm6 so 
quickly, and then subside, as stated at 
page 1 1 , continuing in their severest fi3rm 
so short a time, that the effects of change 
of place can hardly be duly estimated. 
We know that a body of troops having 
suffered severely from Cholera, and re- 
maining at the same station during the 
disease, and after its subsidence ; has in 
many instances been unhealthy for five or 
six months afterwards: suffering from 
fevers, and dysentery, with occasional 
cases of Cholera. Places where the 
residents are usually very subject to 



270 CHOLERA. 

fever, have of late years been frequently 
visited by Cholera. These and similar 
iacts afford the grounds on which we 
should be disposed to ascribe the £pi-> 
demic Cholera to some morbid influence 
connected with locality, sudden changes 
of temperature, and humidity ; more 
especially when these morbific causes 
have to act on persons debilitated by dis- 
ease, or fatigue and privations. Troops 
having marched through an unhealthy 
district, and who have been subject to 
much exposure, fatigue, and privations, 
are very liable to the disease ; both on 
the march, and when they halt; whether 
they join a healthy or a sickly camp. 
Although we have positive proof, that 
the worst forms of Cholera have not been 
communicable by means of any virus 
arising from the persons of the sick, in 
India: we cannot ascertain why the 
causes usually exciting Cholera, do not 
invariably produce the same effect ; and 
why numbers of persons are at times ex- 



CHOLERA. 27 1 

posed to all those circumstances, which 
at other times excite the disease, and still 
Cholera does not appear among them^ 
However, as already observed, the same 
immunity frequently happens when per- 
sons are exposed to the ordinary exciting 
causes of Fevers, and many other dis- 
eases ; concerning the proximate cause, 
and essential nature of which, we can 
hardly boast of knowing more than we 
do of Cholera. 

Contagious diseses differ in many re- 
spects from Cholera : they go through 
a regular course, and persons who are 
exposed to the virus by which they are 
produced, only shew signs of disease at 
a certain period after exposure; and 
that interval in the majority of cases 
is uniform* We find nothing of the sort 
in Cholera, which in some cases has 
attacked men the day after landing fi:om 
ship, and second day after arrival from 
sea, as reported by Mr. Scott, in the inr 
stance of a portion of the 4l8t Regiment 



272 GHOLSRA. 

on arrival at Madras roads. If y^e exa* 
mine critically the circumstances con- 
nected with any attack of Epidemic 
Cholera at a station, we find reason to 
conclude, that the disease is dependent 
on some morbific influence connected 
with the locality : for it' often happens, 
that a short time before the appearance 
of numerous severe cases of Cholera in a 
town ; a disordered state of the digestive 
organs, and tendency to diarrho&a and 
nausea from slight causes, have been ob- 
served among numbers of the inhabitants ; 
after which the Epidemic Cholera bursts 
forth suddenly, affecting numbers of 
persons at the same time ; and in many 
instances, attacking persons who have 
had no sort of communication with those 
who were suffering from the disease.* 
Those who are sickly and predisposed, 
are destroyed in three or four days, and 
at the end of another week, the severe 
form of Cholera disappears: There is 
no progressive course, or succession of 



CHOLSRA. 273 

attacks in the individuals of a town, du* 
ring a severe visitation of the disease ; 
so as to warrant the belief thq.t it is com. 
inunicated by a virus received from sick 
persons. Diseases which are distinctly 
proved to be contagious, namely Variola, 
Rubeolfiy Pertussis, and some others; 
attack persons in good health, nef^rly as 
readily as they do the debilitated and 
infirm ; without being influenced by 
abrupt atmospheric vicissitudes, in the 
degree to which Cholera seems to haye 
been, on aliitiost every occasion when the 
severest e]>idemic visitations have occur- 
red. Nevertheless, we arp obliged to 
acknowledge that the contagion of Fe- 
vers readily afiects persons sufiering 
from poverty and mental inquietude, ex- 
posed to much fatigue, ill fed, and insu^ 
ficiently clothed : ' while men who are in 
circumstances which enable th<sm to pre- 
serve a tranquil state of mind, and whose 
digestive organs and general health are 
unimpaired, are Very often exposed to 

n3 



274 CHOLERA. 

similar degrees of febrile contagion, with 
impunity. The extreme proclivity t6 
Cholera, produced by debUity, from 
whatever cause it arises, is also a very 
remarkable fact. 

Having already stated the entire ex- 
emption from Cholera, of those persons 
employed in. the General Hospital, and 
who were most exposed to unreserved and 
constant communication with the sick ; 
I am desirous to mention that when 
Epidemic Cholera has prevailed in Cal<- 
cutta, and M'e have had numerous admis- 
sions of that disease into General Hospi- 
tal, more especially if the wards have 
been much crowded at the time ; we 
have very frequently had sick and con- 
valescents attacked in Hospital ; and 
there has evidently been a strong ten- 
dency among the patients who have 
been for many days, or weeks under 
treatment for other diseases, to lapse 
into the low form of Cholera, with early 
accession of collapse, coldness, andces- 



CHOLERA. 275 

sation of the pulse.* It has generally 
happened that those attacked in this 
manner, have been in parts of the Hos- 
pital remote from Cholera patients; 
very often in a different building, and 
precluded from any direct communica- 
tion with those who were brought in 
with Cholera. Moreover^ these cases 
of the disease occurring in Hospital, 
have generally happened at times when 
we knew that severe and sudden attacks 
were frequently occurring in persons 
living at various and distant parts of 
the town and suburbs of Calcutta. 

I have never known a man to be at- 
tacked by Cholera in Hospital, whose 
bed was next to that of a man suffering 
from the disease : and the only two in- 
stances where Cholera supervened on 
other diseases, in men already in Hos- 



* See pages 16 and 20. 



S76 CHOLERA. 

pital, and in the same room with Cho- 
lera patients, were the following : 

Case XLVI.— Benjamin Fowle, was 
admitted into Hospital on the 1 5th No* 
vember, 1830, labouring under Cholera 
in an advanced stage of collapse; he 
died in the course of the night. His bed 
was the fourth from that of the patient 
whose case is next to be mentioned. 

Case XLVII.-^Janies Poste, a taU 
man, 20 years of age, recently arrived 
from Europe^ : came to Hospital at 8 a.m. 
on the 14th November, 1830. He had 
been ill fourteen days with dysente- 
ry, and induration of tiie coecum ; for 
which he had used calomel, and his 
mouth had been sore for one week be* 
fore he came under mf care. On ad- 
mission, he was suffering from pyreida, 
induration of the belly, and the usual 
dysenteric symptoms in an aggravated 



CHOLERA. 277 

degree, and he voided much blood. He 
was freely bled from the arm, and seemed 
to be improving daily, till he was seized 
with Cholera at 10 p.m. on the 17th No- 
vember ; the vomiting was frequent and 
Violent, and he voided by stool a clear 
water, in which seven or eight small flat 
pieces of faeces were observed ; they were 
of natural colour, and the size of a flat<^ 
ten pea. This man sunk rapidly, atid 
died at Q a.m. on the 18th November. 
On postrmortem examination, eleven 
hours after death, the subject was found 
not much emaciated. There was much 
venous congestion at the ba^e of the 
lungs. Liver, gall^bladder> and biliary 
ducts perfectly healthy; omentum, mesen- 
tery, and mesocolon, very vascular. The 
stomach and small intestines were dia-^ 
tended with gas, and exterQally of a 
pink colour ; their coat§ very little 
thickened ; but there wa:^ no $ort of mor- 
bid vaseutarity of their mucous surface : 
there wa$ a small quantity of thin subal- 



278 CHOLERA. 

bid mucus, like flour and water, in the 
stomach and small intestines. The cce^ 
cum was distended with gas: and there 
was a small abscess, surrounded with 
much induration, found between the cce- 
cum and the iliacus muscle ; and in the 
abscess a small rounded earthy mass, 
larger than the stone of an olive. There 
was no opening from the abscess into the 
intestine, but a small aperture commu- 
nicating with the appendix vermiformis : 
and the natural aperture from the appen- 
dix into the intestine was closed. The 
whole of the colon, except the ascending 
portion, was contracted, and a few su- 
perficial ulcers were observed on its mu- 
cous membrane : there were several dark 
purple ecchymosed spots, like scorbutic 
blotches, on the peritoneal surface of the 
transverse colon ; but no corresponding 
ulcers on the interior of the intestine. 
Many of the men who came from Eu- 
rope, in the same ship with this patient, 
were suflFering from a scorbutic condi- 



CHOLERA. 279 

tion, on landing. This man, in addition 
to Dysentery, had an abscess exterior to 
the coecum ; which appears to have been 
excited by the stone of some fruit having 
got into the appendix venniformis,where 
it caused inflammation, adhesion of parts, 
and abscess exterior to the intestine. 

* 

The only other patient attacked with 
Cholera, in this ward, in the course of this 
month, was placed in the opposite side of 
the room, about twenty-six feet from the 
place where Poste died : but he did not 
come into Hospital until four days after 
the death of the last-named man : and 
although I have no reason to suspect 
that his disease could be ascribed to any 
contagious influence generated by the 
other two patients; I will mention the 
particulars of his illness. 

Case XLVIII.— Samuel Cox, iEt. 22, 
arrived from Europe on the 10th No- 
vember, 1830, and was admitted into 



280 CHOLERA. 

General Hospital on the 22d, with very 
severe Dysentery, attended by much 
pyrexia, and some enlargement of the 
liver. This man was twice freely bled 
from the arm ; and had leches applied 
to the belly daily till the 25th ; and the 
other remedies usually ordered in Dy- 
sentery were employed. On the morn- 
ing of the 96th, some slight appearances 
of Cholera were manifest ; such as anx- 
iety, languor, and exhaustion, with in- 
clination to vomit. He had had ten 
stools between midnight and 6 A.M. ; the 
evacuations a scanty watery fluid, tinged 
with blood. 

The ease was carefully watched, and 
mediipine omitted. From 6 a.m. to 4 p.m. 
he had twenty stools, the saine as above 
described; anxiety and debility werq 
much increased. Still we were unwil- 
ling to consider it an attack of Cholera, 
and as the man's ai|ments had been so 
distinctly febrile and inflammatory, there 



CHOLERA. 281 

was Iqss fear af sudden collapse from 
waiting a few hours. From 4 to 10 p.m. 
he vomited very often, and had four 
stools, in appearance like pure water; 
he suffered from cramps in the right 
thigh and belly ; the pulse was feeble ; 
tongue cold, moist, and blanched, or 
bloodless, lik^ a piece of flesh that had 
been steeped in water ; and his counte- 
nance was expressive of that extreme 
anxiety and exhaustion so remarkable ib 
Cholera. He was ordered to take two 
grains of opium with twenty grains of calo- 
mel in pills, and ioomediately after them 
a cup of hot sago, with ; iss. of brandy. 
He soon became warmer, and the pulse 
revived; the vomiting and disorder of 
the stomach and bowels were arrested; 
he slept, and the Cholera sym|)toms 
ceased. Afterwards the dysenteric af. 
fection, with bloody evacuations, be- 
came again predominant, and was only 
cured by a long and careful treatment. 



282 CHOLERA. 

He left Hospital quite well on the 12th 
January, 1831. 

We have no doubt that debilitating 
diseases of any sort, and more particu- 
larly bowel complaints, render patients in 
Hospital very liable to attacks of Cholera 
of the worst description ; but I am un- 
acquainted with the history of any hos- 
pital, which affords proof, that the most 
aggravated forms of Cholera have ever 
proved contagious. 

Mr. Hitchcock's account of the Cho- 
lera on board the H. C. ship Abercrombie 
Robinson, exhibits an excellent example 
of the proclivity which debility and im- 
paired health induce to attacks of the 
worst and most untractable descriptions 
of Cholera. That ship, direct from 
Europe, arrived at Bombay on the 4th 
June, 1828, and sailed from thence for 
China on the morning of the IQth Au* 



CHOLERA. 283 

gust : during this long detention in har- 
bour, the greater part of the crew had 
suffered from the ordinary diseases of 
Europeans on arrival in hot climates, by 
which the constitutions of many of the 
men had become impaired. 

. On the morning of the 10th August, 
before leaving harbour, the boatswain 
had a violent attack of Spasmodic Cho- 
lera : and no other case of the disease 
appeared till the night of the 12th, when 
two of the crew were taken ill with the 
low form of Cholera, attended by early 
collapse, but did not report their illness 
till the next morning. In the course of 
a few days, thirty-eight men we^e at- 
tacked with the disease. 

Of these, ten men were at the time in the 
sick list, and they all died ; ten more were 
weak and in bad health, in consequence 
of former illness, while in Bombay har- 
bour — of these seven died, and three re-, 
covered ; the remaining eighteen were 



284 CHOLERA. 

well, and at duty when attached — of these 
seven died, and eleven recovered. The 
men who first fell ill^ with the exception 
of the boatswain, had the low form of 
the disease, which commenced with col- 
lapse ; those occurring' at a later pe- 
riod suffered from the inflammatory and 
febrile form of Cholera. Mr. Hitch- 
cock's narrative is the most complete ac- 
count I have seen of a local epidemic 
attack of Cholera : it exhibits all the 
circumstances connected with the disease 
on board a ship, whose crew consisted of 
about 150 men. 

When we observe Cholera to have 
appeared progressively along great roads 
and navigable rivers; where frequent 
communications by travellers, and much 
commercial intercourse exists; the idea 
of contagion is readily suggested, an^ it 
is not easy for any one to give positive 
proof that such idea is erroneous, except 
a person were on the spot, and able to 



CHOLERA. 285 

examine all the circumstances connected 
with the origin of the disease, at the 
time when it was supposed to have been 
produced by means of contagion. When 
Cholera appears in a town on a much 
frequented road, it is always possible to 
ascribe its importation to the travellers 
last arrived. When a proclivity to the 
disease exists at a station, from some 
circumscribed endemic influence; it is 
evident that when travellers arrive after 
long journeys, during which they had 
been deprived of their ordinary domici- 
liary comforts, and subjected abruptly to 
change of air, water, and food : they 
are under circumstances in some respects 
resembling our recruits on arrival from 
Europe, who are prone Xo the severest 
forms of the disease. Thus predisposed, 
it is not surprising that travellers arriv- 
ing at a town should be the first attack* 
ed, when the disease was on the verge 
of breaking out among the residents. 
Much the same observation may be made 



286 CHOLERA. 

respecting ships trading to a port at 
which Cholera appears : the arrival near- 
est to the appearance of Cholera is 
likely to bear the blame of having 
brought the contagion. If we assume 
that Cholera is contagious, and look only 
at those circumstances where it is possi- 
ble the disease may have been communi- 
cated by personal intercourse; many 
circumstances may be found where con- 
tagion might be suspected : but proofs of 
the fact are wainting in India, while 
proofs adverse to the belief In contagion 

are numierous. 

* 

The character which the Cholera has 
assumed iu many places in Russia, name- 
ly its going through a febrile stage in 
almost all cases, prior to the fatal termi- 
nation; would render it possible that 
some modifications of the fever may be^ 
productive of contagion, among a crowd- 
ed population, where numerous cases of 
the disease are occurring about the 



CHOLEkA. 287 

same time. However, the few accounts 
of the Cholera in Russia, which I have 
seen, describe precisely the blue Cholera 
of India, as predominant among the most 
early and most frequent cases of each 
local epidemic visitation ; terminating 
rapidly without re-action, as it often 
does in Bengal. I observe that Cholera 
has appeared at some Russian stations, 
in violent forms ; attacking persons re- 
siding in distant parts of the town, who 
had no sort of intercourse with each 
other, or with those who could be sus- 
pected of aflfbrding contagion : this was 
the case at Riga, as appears by the re- 
port of the Inspector Z). Dyrseriy dated 
14th May, 1831. 

It is only by the most accurate inquiry 
at the time when the violent attacks of 
Cholera happen in a town, that any cor- 
rect judgment can be formed whether 
the disease be contagious or not. A re- 
markable instance occurred at Razupna, 



288 CHOLERA. 

where there appeared strong reason to 
suspect contagion; but after the most 
rigid investigation instituted by Dr. Schu- 
mov, it was proved on the clearest evi- 
dence, that there was no just ground for 
asserting that the Cholera had been on 
that occasion communicated by conta- 
gion. The circumstances alluded to were 
as follow : 

In the year 1830, when the Cholera 
prevailed at Orenberg, a man went from 
thence to Razupna; immediately after 
his arrival at that place, he was attacked 
with Cholera, and soon died. Four days 
after this man's death, several of the garri- 
son of Razupna were attacked with Cho- 
lera. A most careful inquiry was imme- 
diately instituted ; whereby it was proved 
that not one of those who were taken ill, 
had seen, or attended on, or been near 
the man who was alleged to have brought - 
the disease from Orenberg : but on the - 
contrary, several persons who had visit- 



CHOLERA. 289 

ed this man and attended oh him during 
his illness, escaped without suffering any 
sort of indisposition : the result of the 
inquiry, afforded complete proof that in 
this instaiace the suspicion of contagion 
was unfounded. 

I leave the question, whether the 
Cholera in Russia has been generally 
contagious, to the decision of thosfe 
learned physicians on the spot, who have 
such ample opportunities of investigat- 
ing the characters of the disease. Hav- 
ing witnessed the ravages of the Cholera 
so long in this country, we have the 
most profound interest in the accounts 
of the nature and progress of the malady 
in Europe. When we observe that the 
inhabitants of the hill-provinces of Bri- 
tish India live in small, close, ill-venti- 
lated houses ; and are clothed in woollen 
garments, which the poorer classes caii 
rarely change; we might expect to find^ 
that if Cholera were hereafter to appear 

o 



290 CHOLERA. 

ia those distritcts, its characters may re* 
semble in every respept the disease now 
prevailing in Russia. Without assum- 
ing that we have sufficient grounds, to 
deny that Cholera may be contagious in 
those countries of the north of Europe, 
where it now rages ; we might ask, what 
good has quarantine and the cordon sa- 
nitaire done ? Has it either prevented the 
appearance of the disease, or retarded its 
progress in any country; or can it be sup- . 
posed to have excluded the Cholera from 
a single house or town, in half as many in- 
stances, as we know the severest forms of 
Cholera to have existed, where intercourse 
with the sick was in no manner restrict- 
ed, and still the Cholera was not pro- 
pagated. Whether quarantine regula- 
tions be deemed requisite or not; it is 
probable that the malignant nature, and 
rapid extension of the Cholera, may be 
modified and restrained, by improving 
the drainage and ventilation of towns 
and their vicinity, in those parts of the 



CHOLERA. 291 

country where Cholera exists, or towards 
which it seems extending: hy repairing 
the dwellings of the poorer inhabitants, 
^nd affording supplies of clothing and 
food, at such moderate prices as they 
can afford sufficiently to provide for their 
wants. Enjoining moderation in labo- 
rious occupations, and the strictest tem- 
perance in all habits : restricting the 
working hours in great factories, where 
the severity of labour, or continuance of 
occupation, appear very exhausting to 
human strength. We might also advise 
, early attention to any irregularity of the 
bowels, whether from diarrhoea or from 
constipation ; and the propriety of avoid- 
ing drastic or cold saline purges, when- 
ever a disposition to Cholera has been 
manifested in the vicinity. 

The early symptoms of most cases of 
Cholera, appearing connected with ge- 
neral disorder of the mucous membranes ; 
it will be proper in cold seasons to ob« 



292 CHOLERA. 

serve carefully the progress of febrile 
catarrhal affections; for the purpose of 
ascertaining whether any relation exists 
between those complaints, and to notice 
their mutual influence on each other. 



THE END. 



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